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Full text of "A treatise on the venereal disease"

NATIONAL LIBRARY OF MEDICINE 
Washington 




Founded 1836 



U. S. Department of Health, Education, and Welfare 



Public Health Service 






TREATISE 



OiV THE 



VENEREAL DISEASE. 
- 

BY JOHN HUNTER. 



WITH AN 



INTRODUCTION AND COMMENTARY, 

BY JOSEPH ADAMS, M. D. 

AUTHOR OF OBSERVATIONS ON MORBID POISONS, &C. 

FIRST AMERICAN EDITION. 



— 



PHILADELPHIA: 

PUBLISHED BY J. WEBSTER, NO. 10, SOUTH EIGHTH STREET. 

W, BROWN, TRINTER, PRUNE STREET. 

1818. 



TO 

THE STUDENTS OF MEDICINE 

IN THE 

UNIVERSITY OF PENNSYLVANIA, 

INCITED BY WHOSE RECOMMENDATIONS, AND RELYING UPON 
WHOSE ENCOURAGEMENT, 

THIS WORK HAS BEEN REPRINTED, 
THE PUBLISHER, 

WITH EVERY FEELING OF RESPECT AND GRATITUDE, 
BEGS PERMISSION TO DEDICATE IT. 

J. WEBSTER. 



PREFACE 



TO THE 



FIRST AMERICAN EDITION. 



The present edition of John Hunter's Treatise on the 
Venereal Disease, has been rendered necessary by the 
permanent demand for this book among the medical pro- 
fession, who are well apprized of its value. The disease 
itself, may experience frequent variations in its type ; and 
the practice applied to it, may change with the changing 
fashion of medical opinions; but a book which contains so 
full, so complete, so lucid, and so satisfactory an analysis 
of the disease, in its origin, and in the varieties of ap- 
pearance it assumes, can never be out of date, while just 
notions of the physiology of the human frame, and of the 
pathology of its morbid affections, shall constitute part of 
a physician's study. 

Previous to Mr. John Hunter's Treatise on this subject, 
the profession possessed none, which, by just views of the 
disease itself, led to rational practice upon just principles. 
Before this work appeared, the prescriptions for Syphilis, 
though often successful, were empirical; they were pre- 
scribed on the authority of routine, rather than on pro- 
found views of the nature of the disorder. It was re- 
served for John Hunter to lay the foundations of sound 



VI PREFACE TO THE 

and discriminating practice, by investigations which time 
has only served to confirm. Indeed, the English school 
of physiology may be said to have started into eminence 
with this great man; and his views of the animal system, 
whether in its sane, or its morbid state, have stood the 
test of investigation and experience from his time to the 
present. 

While the disease in question shall continue to rank 
among the prominent evils to which the human race is 
liable, this Treatise on the subject, will remain an indispen- 
sable source of information to physicians who wish to un- 
derstand the nature of the poison they are called upon to 
expel. No publication previous to it, nor indeed did all 
of them together, throw equal light on the subject with 
Mr. Hunter's work; nor has any subsequent publication 
attempted to supersede it. Doubts have arisen, and in- 
vestigations have taken place in consequence of them, 
owing to the occasional obscurity of manner adopted by 
the author; who seems to have taken for granted that the 
public were as fully apprized of the physiological views to 
which he sometimes indirectly alludes, as the pupils who 
benefitted by his instructions. The want of a commen- 
tator, therefore, has been felt, and called for. Of those 
who have attempted this task, none have been so well 
qualified as Dr. Adams, whose reputation as a medical 
writer is of the first rank, and who had sufficient oppor- 
tunities of entering fully into all Mr. John Hunter's doc- 
trines and ideas. The Treatise, elucidated with the notes 
and commentaries of this able physician, is likely to con- 
tinue, as it now is, the stock book of the profession on the 



FIRST AMERICAN EDITION. VII 

disease of which it treats. The character of the original 
work has been so long and so firmly established, and the 
notes of Dr. Adams so well received in the medical world, 
that there is no doubt of the propriety of a new edition to 
supply the demands of the profession. As every care has 
been taken to render the present edition neat, accurate, 
and reasonable, the publisher hopes it will meet with the 
encouragement of gentlemen engaged in the study and 
practice of medicine^ whose approbation he has faithfully 
endeavoured on the present occasion to earn. 

The reputation of the author, and of his commentator, 
is such, as to dispense with the necessity of any additional 
notes to a work so full and so perfect in itself. It is 
therefore published verbatim from the London copy of Dr. 
Adams's edition. 

James Webster. 



TO THE MEMORY 

OF THAT 

GUIDE, PHILOSOPHER, AND FRIEND, 

"WHO FIRST LED 

HIS COMMENTATOR 

TO 

REASON ON SUBJECTS OF PATHOLOGY, 

THESE PAGES ARE CONSECRATED, 

WITH 

SENTIMENTS OP GRATITUDE, 

WHICH 

TIME CAN NEVER DIMINISH. 



COMMENTATOR'S PREFACE. 



WHEN we consider, that, before Sydenham wrote, 
there existed no systematic description of gout or small- 
pox, we shall be less surprised, that, before Mr. Hunter, 
only the more obvious symptoms and methods of cure had 
been noticed in a disease, which for three centuries had 
engaged the pens of the most celebrated medical writers. 
But Sydenham, though so accurate in his description of 
facts, accounted for them by causes which never existed, 
and the admission of which by others proved subversive 
of his admirable practice. Mr. Hunter has reduced to 
order a series of facts supposed to be reducible to no laws: 
shewn the source of former errors, the cause of every ap- 
parent irregularity, and, in fixing the true character of 
one disease, has introduced us to others never before sus- 
pected to exist. His practice has, therefore, become 
popular, in proportion as his theory is understood. 

It cannot be wondered, if doctrines entirely new should 
require a language in many respects new .also. What 
appeared, however, a new language was, for the most part, 
only the introduction of precise terms, instead of figura- 
tive expressions. If it should seem strange, that any dif- 
ficulty should attend describing a plain matter of fact, or 
in understanding such a description, let us recollect, that 
in every art or science the great difficulty is to delineate 
nature, and that but few adepts are alive to the nicer and 
most accurate parts of such delineations. 



xii commentator's preface. 

Mr. Hunter found himself so frequently ill understood, 
that at last he was prevailed on to believe there must be 
some incapacity about him in the use of common language. 
That he was totally unacquainted with those ornaments 
in writing or speaking which serve to illustrate a subject, 
or to awaken the attention, cannot be questioned; but his 
language was always as perspicuous as might be expected 
from the clearness of his conceptions. This language, 
however, was not popular; and, I believe, if we except 
his posthumous works, he offered nothing to the world, 
till it had been revised by his friends. 

The Treatise on the Venereal Disease was the work 
which he was particularly anxious should come before the 
public in the most perfect form : "lam resolved," said 
he to his Commentator, "that it shall not be a mere book- 
seller's job, every subsequent edition rendering the former 
useless. The truth of the doctrines I have proved so long 
as to reduce them to conviction; and, in order to render 
the language intelligible, I meet a committee of three gen- 
tlemen, to whose correction every page is submitted.'* 
As all this was very generally known, never were expecta- 
tions raised higher of any work, nor in some respects more 
generally disappointed. 

To compliment Mr. Hunter's coadjutors would be su- 
perfluous. Two of them being authors, have convinced 
the world of their abilities in producing original composi- 
tions. Of the third, it is enough to say, he was Dr. David 
Pitcairn. But these gentlemen, accustomed to the best 
company, that is, to each other, and to a circle as enlight- 
ened as themselves, were not aware of the difficulties that 
attended their undertaking. To make Mr. Hunter intel- 
ligible by the short introduction prefixed to this work, ne- 
ver could have entered the conception of men who were 
not previously accustomed to converse with him. It may 



COMMENTATOR S PREFACE. Xlll 

perhaps be fair to add, that, being all of them physicians, 
they were less acquainted with the erroneous opinions and 
practices, and even with the technical language which had 
prevailed before Mr. Hunter taught. 

Though what has been said may be a sufficient apology 
for the commentaries offered in this edition, yet it did not 
seem to authorize any alteration in the text. The value 
of the work will infinitely more than repay the labour of 
studying it with all the application it requires. The ob- 
ject of the Commentator is only to direct the student, and 
to relieve him occasionally in his progress. With these 
views, the following hints are premised: — 

The first business of those who are not familiar with 
Mr. Hunter's opinions will, of course, be to study the in- 
troduction. This should be done with a diligence pro- 
portionate to the difficulties that may be found in admitting 
or even comprehending the various propositions and their 
proofs. These difficulties, in the present day, are very 
much lessened; Mr. Hunter's doctrines having become 
more popular and better understood from the time that they 
were first communicated in his conversations, his lectures, 
and his writings. 

I would advise every medical student to read the whole 
of the book in the order in which it stands. He will find it 
the best introduction to pathological reasoning that his 
closet can afford him. Those chapters, in the Third 
Part, which relate to Stricture and other diseases in the 
urinary passages, may perhaps fatigue his attention with- 
out adding sufficiently to his knowledge. It cannot be 
expected that he should retain the whole in his memory, 
and the remarks being chiefly practical, must be referred 
to as often as intricate cases occur. If therefore these 
chapters are read in their order, the student must not be 
angry with his Author or himself, if he cannot keep up 



Xiv commentator's preface. 

his attention to every minutia. Whenever he has an in- 
tricate case, in his own practice, he will not accuse Mr. 
Hunter of prolixity. 

Another caution, of the same kind, is absolutely neces- 
sary. The student will, on some occasion, find an obscu- 
rity, from an anticipation of terms which cannot be well 
understood, till he arrives at the doctrines to which they 
relate. This is easily accounted for from the manner in 
which the work was compiled. I have endeavoured, as 
often as possible, to relieve him of these difficulties, but 
cannot easily ascertain whether some parts of the work 
will be completely comprehended without a second peru- 
sal; at least, of those passages which were found obscure 
in the first. 

Such is the manner which I would recommend the stu- 
dent to pursue in the perusal of this work. 

Those who have seen something of practice, and wish 
to acquire that systematic knowledge, of the disease, which 
may enable them to act with decision under every difficul- 
ty, should study principally those sections in which the 
doctrine is contained. Most of them are illustrated with 
cases; and I shall be mistaken, if the new light which will 
dawn upon the reader in every passage should hot lead 
him to a careful perusal of the whole work. 

It is probable, that most gentlemen engaged in exten- 
sive practice are already provided with the work as Mr. 
Hunter left it. The present edition can only be useful to 
such of them as, from the multiplicity of their engage- 
ments, or from the difficulty of encountering early opini- 
ons, have not had leisure or patience to acquire a know- 
ledge of Mr. Hunter's doctrines. I would advise ail such 
to study Mr. Hunter clinically, that is, in all cases that 
come under their care, to compare the progress of the 
disease and cure with the descriptions given by Mr. 



commentator's PREFACE. XV 

Hunter. This will render every subject interesting to him ; 
and, if he acquires a decision in diagnosis or practice, it 
will not be the effect of bold guessing, but of well-directed 
reasoning. 

Should what has been added by the Commentator be 
found serviceable to either class of readers, his labour 
will be amply repaid. 



CONTENTS 



PAGE 

Preface to the First American Edition . v 

Preface of the Commentator xi 

Introduction ..... 1 
The Author's reasons for publishing, with the Commentator's remarks 2 
Sect. I. — Of sympathy, 2. — II. Or morbid actions being incompatible with 
each other, 6. — III. Of the comparative powers of different 
parts of the body — from situation — from structure, 8. — IV. Of 
parts susceptible of particular diseases, 9. — V. Of inflam- 
mation, 10.— VI. Of mortification 12 

PART I. 

CHAP. I. — Of the venereal poison, and of other morbid poisons, illustrated 

by the small-pox 16 

Sect. I. — Of the first origin of the poison, 18 -II. Began in the human race, 
and in the parts of generation, 19. — III. Of the nature of the 
poison, 20- — IV. Of the greater or less acrimony of the poi- 
son, 21. — V- Of the poison being the same in gonorrhoea and 
chancres, 22 — the venereal disease unknown in Otaheite, 28. 
— VI. Of the cause of the poisonous quality — fermentation — 
action 29 

CHAP. II. — The mode of venereal infection* 34 

CHAP. III. — Of the different forms of the disease >b. 

Sect. I. — Varieties in different constitutions ..... 35 

CHAP. IV. — Of the lues venerea being the cause of other diseases . 37 

PART II. 

CHAP. I.— Of gonorrhoea 40 

Sect. I. — Of the time between the application of the poison and effect, 42. 
— II. Of the difficulty of distinguishing the virulent from the 
simple gonorrhoea, 44 — III. Of the common final intention of 
suppuration not answering in the present disease, 46. — IV. 
Of the venereal gonorrhoea, 52. — V. Of the seat of the disease 
in both sexes, ibid. — VI. Of the most common symptoms, and 
the order of their appearance, 55. — VII. Of the discharge, 57. 
— VIII. Of the' chordee, 59. — IX. Of the manner in which the 
inflammation attacks the urethra, 60. — X. Of the swelled tes- 
ticle, 64 — XI. Of the swellings of the glands from sympa- 
thy, 66. — XII. Of the diseases of the lymphatics in a gonor- 
rhoea, 6S. — XIII. Short recapitulation of trie varieties in the 
symptoms 69 



SYU1 CONTENTS. 



PAGE 

70 



CHAP. II. — Of the gonorrhoea in women '% 

Sect. I.— Of the proofs of a woman having this disease . • m • 
CHAP. HI.— Of the effects ot the gonorrhoea on the constitution in both 



sexes _ fi 

CHAP. IV.— Of the cure of gonorrhoea . ■ • • • -« 

Sect. I.— Of the different modes of practice— evacuants— astringents, /y. 

—II. Of local applications— dift'erent kinds of injections— nil- 

fating— sedative— emollient— astringent ■ 

CHAP. V. — Of the cure of gonorrhoea in wonven . 

CHAP. VI— Of the treatment of the constitution in the cure of the gonor- 

h. oo 

oea • • „. 

CHAP. VII.— Of the treatment of occasional symptoms of the gonorrhoea yi 
Sect. I.— Of the bleeding from the urethra, 92— H. Of preventing pain- 
ful erections, ibid— III. Of ihe treatment of the chordee, ibid. 
—IV. Of the treatment of the suppuration of the glands of the 
urethra, 93.— V. Of the treatment ot the affection of the blad- 
der from gonorrhoea, 94.— VI. Of the treatment of the swelled 
testicle, ibid.— VII. Of the decline and termination ot the 
symptoms of gonorrhoea ...... y ' 

CHAP. VIII.— Observations on the symptoms which often remain alter the 

disease is subdued ....••••"* 

Sect. I.— Of the remains of the disagreeable sensations excited by the 
original disease, 100.— II. Of a gleet, 102.— 111. Of the cure of 
gleets— constitutionally— locally, 104.— IV. Of the remaining 
chordee, 108.— V. Of the continuance of the irritation of the 
bladder, 109.— VI. Of the remaining hardness of the epididymis ib. 

PART III. 

CHAP. 1.— Of diseases supposed to arise inconsequence of venereal inflam- 
mation in the urethra ot men no 

Sect. I. — Of strictures 112 

CHAP. II.— Of the permanent stricture H-> 

Sect. I.— Of the bougie, 118.— 11. Of the treatment of the permanent 
stricture, 119.— Ill- Of the cure of the stricture by ulceration, 
123. — IV. Of the application of a caustic to strictures . 126 

CHAP. 111.— Of strictures in women 129 

Sect. 1.— Of the cure of strictures in women, 130.— 11. Of the gleet in 

consequence of a stricture ...... 131 

CHAP. IV.— Of stricture attended with spasmodic affection . . . ibid 

CHAP. V.— Of some circumstances attending the use of bougies— their fi- 
gure and composition ....... 133 

Sect. I. — Of a new passage formed by bougies .... 135 

CHAP. VI- — Of diseases inconsequence of a permanent stricture in urethra 139 
Sect. 1. — Of the enlargement of the urethra, 139- — II. OF the formation of 
a new passage for the urine, 140- — III. Of inflammation in the 
parts surrounding the urethra, 145. — IV. Of the treatment of 
the inflammation in surrounding parts, 147- — V. Of the effects 
of inflammation in the surrounding parts upon the constitu- 
tion, 149. — VI- Of fistulae in perinax), 150. — VII. Of the opera- 
tion for fistula: in perinso ...... 150 

CHAP. VII. — Of some other affections of the urethra .... 154 

Sect. I- — Of the spasmodic affections of the urethra, ibid. — II. Of the cure 
of the spasmodic affections of the urethra, 156. — III. Ofthe pa- 
ralysis of the urethra, 157. — IV. Cure ofthe paralysis of the 
urethra, 158. — V- Of caruncles or excrescences in the ure- 
thra, 159. — VI. Ofthe cure of the excrescences or caruncle 159 

CHAP. — VIII- Ofthe swelled prostate gland. 160 

Sect. — I, Of the treatment of the swelled prostate gland • • 164 



COJSTENTS. XIX 

PAGE 

CHAP. IX.— -OK the diseases of the bladder, particularly from the before- 
mentioned obstructions to the urine .... 165 
Sect. I. — Of the treatment where the actions of the urethra and bladder 
do not exactly alternate, 168. — II. Of the paralysis of the 
bladder from obstruction to the passage of the urine, 168. — 
III. Or the cure of the paralysis ot the bladder from obstruc- 
tion arising from pressure or spasm . 171 

CHAP. X. — Ot a suppression of urine and operations for the cure of it . 172 
Sect. I. — Of allowing a catheter to remain in the urethra and bladder, 
178. — II. Of the increased strength of the bladder, 179.— Of 
the distention of the ureters, 180. — IV. Of irritability in the 
bladder independent of obstructions to the passage of the 
mine, 180. — V. Of the cure of simple irritability of the blad- 
der, 181. — VI. Of a paralysis of the accelerators urinae . 182 

CHAP. XI. — Of the discharge of the natural mucus of the glands of the ure- 
thra ., 182 

Sect. I. — Of the discha^e of the secretion.-* of the prostate gland and 

vesiculxseminales . . . . . • ■ . 183 

CHAP. XII— Of impotence 185 

Sect. I. — Of impotence depending on the mind, 186. — II. Of impotence 
from a want of proper correspondence between the actions of 
the different organs ....... 188 

CHAP. XIII— Of the decay of the testicle 19J 

PART IV. 

CHAP. I.— Of Chancre 198 

Skct. I. — Of the phymosis and paraphymosis ..... 205 
CHAP. II.— Of chancres in women 208 

CHAP. III. — General observations on the treatment of chancres . . 209 
Sect. I. — Of the destruction of a chancre, 212. — II. Of the cure of chan- 
cres — local applications, 213. — III. Of the treatment of phymo- 
sis in consequence of, or attended with chancre, 215 — IV. Of 
the common operation for the phymosis produced by chan- 
cres, 217. — V. Of the constitutional treatment of phymosis, 219. 
— VI. Of the treatment of the paraphymosis from chancres, 220. 
— VII. Of the cure of chancres by mercury given internally 22l 

CHAP. IV. — Of the cure of chancres in women 227 

CHAP. V- — Ofsomeof the consequences of chancres — and the treatment of 

them ibid 

Sbct. I. — Ofdispositions to new diseases during the cure of chancres, 228. 
— II. Of ulceration resembling chancres, 230. — III. Of a thick- 
ening and hardening the parts, 231. — IV. Of warts, 232. — V. 
Of excoriations of the glans and prepuce • • 234 

PART V. 

CHAP. I— Of bubo 235 

CHAP. II.— Of buboes in women 243 

CHAP. 111. — Of the inflammation of buboes, and the marks that distinguish 

them from other swellings of the glands . . . 244 

CHAP. IV. — General reflections on the cure of buboes .... 243 
Sect. I. — Of resolution of the inflammation of the absorbents on the pe- 
nis, 251. — II. Of the resolution of buboes in the groin, ibid. — 
III. Of the resolution of buboes in women, 252. — IV. Of buboes 
in other parts, 253. — V. Of the quantity of mercury necessary 
for the resolution of a bubo, ibid. — VI. Of the treatment of 

buboes when they suppurate 254 

CHAP. V. — Of some of the consequences of buboes .... 25| 



XX CONTENTS. 



PART VJ. 

CHAP. I. — Of the lues venerea, introductory remarks . . • 262 

Sect. I. — Of the nature of the sores or ulcers proceeding from the lues 
venerea, 265. — II. Of the matter from sores in the lues venerea 
compared with that from chancres and buboes, 269. — III. Of the 
local effects arising from the constitution considered as criti- 
cal — symptomatic fever, 275. — IV. Of the local and constitu- 
tional forms of the disease never interfering with one another, 
278. — V. Of the supposed termination of the lues venerea in 
other diseases, ibid. — VI. Of the specific distance of the vene- 
real inflammation, 279. — VII. Of the parts most susceptible of 
the lues venerea — of the time and manner in which they are 
affected — what is meant by contamination, disposition, and ac- 
tion — summary of ,the doctrine, 281.— f Last conversation be- 
tween Mr. Hunter and the commentator .... 292 

CHAP. II. — Of the symptoms of the lues venerea ..... . 293 

Sect. I. — Of the symptoms of the first stage of the lues venerea, 297. — 
II. Experiments made to ascertain the progress and effects of 
the venereal poison, 302- — HI. Of the symptoms of the second 
stage of the lues venerea, 304. — IV. Of the effects of the poi- 
son on the constitution ....... 306 

CHAP. III. — General observations on the cure of the lues venerea . 307 

Sect. I. — Of the use of mercury in the cure of the lues venerea, 312 II. 

Of the quantity of mercury necessary to be given, 317. — HI. 
Of the sensible effects of mercury upon parts, 318. — IV. Of the 
action of mercury, 520. — V. Of the different methods of giv- 
ing mercury— externally — internally, 323. — VI. Of the cure of 
the disease in the second or third stage, 328. — VII. Of local 
treatment, 331. — VIII. Of abscesses— exfoliation, 332. — IX. 
Of nodes on tendons, ligaments, and fasciae, 333 — X. Of cor- 
recting some of the effects of mercury, ibid. — XI. Of the form 
of the different preparations of mercury when in the circula- 
tion, 336. — XII. Of the operation of mercury on the poison, 
338— XIII. Of gum guaiacum, and radix sarsaparilla, in the 
venereal disease ........ 340 

CHAP. IV.— Of the effects remaining after the disease is cured, and of the 

diseases sometimes produced by the cure . . . 342 
Sect. I. — General observations on the (medicines usually given for the 

cure, 344.— II. Of the continuance of the spitting . 347 

CHAP. V. — Of preventing the venereal disease ..... 348 

PART VII. 

Introductory remarks . 35Q 

CHAP. I.— Of diseases resembling the lues venerea, which have been mis- 
taken for it 351 

Skct. I.— Of diseases supposed to be venereal, produced by transplanted 

teeth 3 61 



Explanation of Plates 
Index . 



v 



INTRODUCTION. 



TWO motives have induced me to publish the following trea* 
tise. In the first place, I am not without hope, that several new ob- 
servations contained in it will be deemed worthy of the public atten- 
tion; in the next place, I am desirous to have an opportunity of shew- 
ing from whom some opinions, that have made their way into the 
medical world, originated. 

But, as much of the theory, which will often be referred to in the 
course of this work, is peculiar to myself, it seems necessary to give 
an introductory explanation of some parts of it, in order that the 
terms used may be the more intelligible to the reader. 



COMMENTARY. 

Mr. Hunter, like all those who have improved medicine, has been 
more unfortunate than other philosophers in the manner in which his 
theories have made their way into the world, and in the persons who 
have attempted to undervalue them. When Sir Isaac Newton's opi- 
nions were objected to by men, however inferior to himself, the argu- 
ments adduced were not only connected with inquiries in which all 
philosophers are engaged, but the proofs were reducible to demon- 
strations which are the perpetual objects of experiment, or to pro- 
blems, the mode of solving which was familiar to such as ventured to 
engage in the controversy. Every adversary too was under some ne- 
cessity of at least comprehending the meaning of the author, and the 
readers were very much confined to those who were able to judge. 
The objects of the dispute were permanent in their appearance, and 
the foundation of the reasoning was laid on laws which never vary. 

But in reducing disease to certain laws, we must catch the tran- 
sient picture as it passes. In explaining ourselves, we must refer not 
to the common, but the altered appearance of nature, and to altera- 
tions varying in shades not only according to seasons and unknown 
combinations of the atmosphere, but according to the variety of con- 
stitutions in different subjects, and even in different conditions of the 
same. 

It is not easy to rob a Newton of his discoveries. To be known, 
they must not only be published, but the series of arguments leading 

A 



INTRODUCTION. SECT. I- 



to them must appear before they can be received. They cannot float 
on the surface in such a manner that parts maybe collected, and be- 
come the property of others, or become common property, before any 
one is aware to whom he is indebted for them. 

Such is not the case with any pathological fact, all of which must 
be ascertained by a vast number of cases, each of which will vary 
in certain points, though not in those which are to be considered as 
the laws of a disease. Thus whilst a Newton is solving his problem 
in his closet, a Sydenham must be tracing at every bed-side the ge- 
neral uniformity of certain appearances at certain stages of a disease, 
the occasional aberration from those appearances, and the signs which 
may lead to expect such aberrations. Whilst the first may refer to 
a single phenomenon open to universal inspection, the other can only 
refer to facts which, from incapacity or indolence, are overlooked by 
those who alone have the opportunity of tracing them, and whose duty 
should lead to no other inquiry. But to these an easier road for tem- 
porary fame and immediate emolument too often occurs. Such parts 
of a discovery as are more readily comprehended are conveyed in 
easy language to the public, or to the younger branch of the profes- 
sion; every difficulty is passed over, all the intricacies of research are 
given up, and a few solitary facts, which could only be first known 
by tracing a series of laws, are spoken of without any reference to the 
inventor. If Mr. Hunter was forced to submit to this injustice, he 
suffered it in common with Sydenham. If he complained without 
knowing how to redress himself, his friends may plead the same ex- 
ample. 

When we consider that the whole of the theory is peculiarly Mr. 
Hunter's, it will at once occur, that so short an introduction is very 
inadequate. To Mr. Hunter, and those about him, particularly those 
who corrected his work, the theory might be so familiar as to render 
them incompetent judges of difficulties which others may feel in turn- 
ing their minds to a new mode of reasoning. 



SECTION I 

Of Sympathy. 

I divide sympathy into two kinds; universal, and partial 
Universal sympathy is an affection wherein the whole constitution 
sympathizes.with some sensation or action. Partial sympathy is an 
affection wherein one or more distinct parts sympathize with some 
local sensation or action. 



SECT. I. INTRODUCTION. 3 

The universal sympathies are different in different diseases; but 
those that occur in the venereal disease are principally two: the symp- 
tomatic fever and the hectie fever. The symptomatic fever is an im- 
mediate effect of some local injury, and seldom takes place in the 
venereal disease in any great degree under any of its forms, except in 
the case of a swelled testicle, which is itself an instance of a partial 
sympathy; the symptomatic fever here, therefore, is an universal 
sympathy arising from a partial one. The hectic fever is an univer- 
sal sympathy with a local disease, which the constitution is not able 
to overcome. This takes place oftener and in a greater degree in the 
lues venerea than in any other form of the disease. 

I divide partial sympathy into three kinds: the remote, the conti- 
guous, and the continuous. The remote is, where there appears to 
be no visible connection of parts from whence we can account for 
such effects, as in the case of pain of the shoulder in an inflamma- 
tion of the liver. The contiguous is, that which appears to have no 
other connection than what arises from vicinity or contact of sepa- 
rate parts; an instance of which we have in the stomach and intes- 
tines sympathizing with the integuments of the abdomen. The con- 
tinuous is, where there is no interruption of parts, and the sympathy 
runs along from the irritating point, as from a centre, which is the 
most common of all sympathies. We have an example of this in the 
spreading of inflammation. 

Mr. Hunter, in his divisions of sympathy, has called each an af- 
fection, arising generally or partially from some local sensation or ac- 
tion. In his illustrations he takes no notice of any sympathies ex- 
cepting from actions. The sympathies from sensation are, partial, 
when weeping or sighing is excited by a melancholy impression on 
the mind; universal, when an universal trembling is excited; when 
all the muscles, which at other times are exerted to preserve the cus- 
tomary form of the countenance, or the erect state of the body, re- 
lax; in consequence of which we see the face lengthened, and the 
lower lip fall, so as to expose part of the teeth. If the relaxation is 
universal and continues, the body will not be supported, and even the 
actions by which the circulation is kept up will cease. Swooning 
follows; and if action is not restored before a certain time, the various 
organs, deprived of their accustomed stimuli, do not recover the 
power of performing their necessary functions, and death follows. 

Mr. Hunter has also thought it unnecessary to give any illustration 
of partial sympathy with diseased actions, yet the want of it renders 
the subsequent paragraph somewhat obscure. The swelled testicle 
in the venereal disease, he observes, is an instance of partial sympa- 
thy; that is, the diseased part is the inflamed urethra, and the part 
which sympathizes is the testicle. If the inflammation in the latter 



4 INTRODUCTION. SECT. E. 

should be very considerable, the whole constitution sympathizes with 
it, and thus universal sympathy is produced. 

The symptomatic fever has alway%.been remarked as attendant on 
local inflammation. In the case of the swelled testicle, from what- 
ever cause, the sympathy is often complicated, for not only does the 
whole constitution sympathize, but the brain is more commonly af- 
fected than in inflammation from other causes. Yet this affection 
does not appear a transfer of the inflammation, because we find it 
cease as the testicle recovers, and the symptoms are not those of true 
phrenzy. 

The hectic fever, till Mr. Hunter's time, was usually considered as 
the effect of matter absorbed. Phthisis pulmonalis and psoas abscess 
seemed to furnish proofs of such a cause. The late Dr. Heberden 
has, however, a very ingenious paper on hectic fever, making the first 
article of the second volume of Medical Transactions. This accu- 
rate writer seems rather to consider the disease as the effect of re- 
peated formations of matter, than of its absorption. He calls it the 
symptomatic, the irregular intermittent, and the fever of suppura- 
tions. The disease itself is most admirably described by him; but 
some parts of the paper are confused, from the difficulty the author 
found in tracing the cause constantly to suppuration. Hence he de- 
scribes the various symptomatic fevers as making different forms of 
the hectic. Thus the shivering from the first formation of matter, 
and the high feverish irritation sometimes consequent on a wounded 
tendon, are all included in the hectic, which would be reasonable 
enough, if the symptomatic fever always became hectic, which we 
shall presently see is not the case. Mr. Hunter, though he considers 
both as the effect of sympathy, yet distinguishes them as arising from 
different causes, and exhibiting different phenomena. The sympto- 
matic fever is usually acute, and arises from, or is only a symptom of, 
some acute local injury, which, throughout all its stages, whether in 
its commencement or its progress to suppuration, is attended with 
shivering and consequent fever. Sydenham has well marked these 
stages in small pox. They occur in every common abscess, if the 
progress is rapid. 

Hectic, or (if we translate the word) habitual* fever, is less acute 
than the symptomatic, but more permanent in its returns. As it al- 
most always attends phthisis pulmonalis, and large incurable ab- 
scesses, it was supposed to arise from the absorption of matter. But 
this error might easily have been removed by reflecting, that in large 

* The Greek word 'ex.7<«o« can scarcely be translated by any oilier word than 
habitual. In both languages it is derived from the same root, from £ v«i habeo, 
( ePtf habitus, and '£>c7«««S habitxi positua,ov,&s we say in English, habitual Ha- 
bitual, though there is no such classical word as halritualis, must be derived 
from the Latin habitus, from which we vernacular 1 ! ze habit. 



SECT. I. INTRODUCTION. 5 

abscesses matter is sometimes absorbed without injury to the constitu- 
tion. Suppuration is one of the curative processes of nature, in 
parts which, cannot return to their original actions, and like other new 
actions is usually ushered in by shivering, and consequent fever. But 
where suppuration is unattended with inflammation, the constitution 
is little affected, so that no shivering or consequent fever arises. 
Thus in the psoas abscess, whilst it is continually enlarging by an in- 
crease of matter, or by fresh suppurations, the constitution is very 
little affected, and in the lungs large tubercles are formed, which sup- 
purate, and whilst the matter remains in the capsules, the constitu- 
tion only suffers from the loss of so much lung. But as soon as the 
abscess is opened by nature or art, or the matter of tubercles finds its 
way to the bronchia, inflammation takes place over the whole sur- 
faces, as the first means by which the part is to be restored; and this 
inflammation is attended with shivering and heat, constituting a pa- 
roxysm of fever. If this attempt made by nature to restore the part 
is ineffectual, she renews it; but this and every future attempt are 
often insufficient to relieve so much mischief as the parts have sus- 
tained. Still, however, the attempt continues as long as the constitu- 
tion retains power to excite inflammation, and each attempt is at- 
tended with a similar paroxysm. Hence the fever becomes habitual, 
or hectic, not from the absorption of matter, but from the repeated 
attempts at restoring parts which cannot be restored. This will be 
further illustrated when we arrive at Mr. Hunter's doctrines concern- 
ing lues venerea. 

Thus the symptomatic and hectic fever are both of them similar, 
inasmuch as they arise from the sympathy of the whole constitution 
with a local disease; and the only difference is, that the former is for 
the most part more acute, and rarely returns more than once or twice, 
after which, if matter is formed, it is either absorbed, or if it comes 
forward to the surface, granulation succeeds, to restore the lost part. 
The hectic, on the contrary, is less violent, in proportion as the con- 
stitution is previously debilitated, but returns as long as strength 
enough remains to attempt the curative process. To bring these 
more immediately to the present purpose — symptomatic fever, in 
swelled testicle, is the sympathy of the constitution with the violent 
inflammation excited. Hectic fever, in lues venerea, is the perpetual 
attempt of the constitution to cure a disease, or to excite such a new 
action as will supersede the disease; but we find, by experience, that 
the constitution is unequal to such an attempt. The attempt, there- 
fore, not having succeeded, is renewed till it becomes habitual; or, 
in other words, " hectic fever is an habitual universal sympathy of 
the constitution, struggling with a disease which it is unable to over- 
come-" 



6 INTRODUCTION. SECT. II. 

SECTION II. 

Of Morbid Actions being incompatible with each other. 

The venereal disease is not only suspeeted to be present in many 
cases where the nature of the disorder is not well marked, but it is 
supposed that it can be combined with other diseases, such as the 
itch and the scurvy. Thus we hear of pocky itch, and of scurvy 
and the venereal disease combined; but this supposition appears to 
me to be founded in error. I have never seen any such cases, nor 
do they seem to be consistent with the principles of morbid action in 
the animal economy. It appears to me, beyond a doubt, that no two 
actions can take place in the same constitution, or in the same part, 
at one and the same time. No two different fevers can exist in the 
same constitution; nor two local diseases in the same part at the 
same time; yet as the venereal disease, when it attacks the skin, 
bears a resemblance to those symptoms which are vulgarly called 
scorbutic, they are often supposed to be mixed and to exist in the 
same part. 

What has been called a scorbutic constitution is no more than a 
constitution very susceptible of an action producing eruptions on the 
skin, whenever an immediate cause takes place; and there are some 
parts of the body more susceptible of this than others, in which, 
therefore, a slighter immediate cause is sufficient to excite the action; 
but the easy susceptibility, with respect to one disease, is not a rea- 
son why a constitution should not likewise be susceptible of other 
diseases. A man may have the pox and the small-pox at the same 
time; that is, parts of his body may have been contaminated by the 
venereal poison, and the small-pox may take place, and both diseases 
may appear together, but not in the same parts. If both were con- 
sequences of fever, and each followed the fever nearly about the 
same time, it would be impossible for each to have its respective 
eruption, even in different parts, at the same time; two fevers, ante- 
cedent to these different diseases, cannot be co-existent. 

From this principle, I think I may fairly put the following que- 
ries. Does not the failure of inoculation, and the power of resisting 
many infections, sometimes arise from the person's having at the 
same time, some other disease, and therefore being incapable of a 
new action? Does not the great difference in the time, from the ap- 
plication of the cause to the appearance of the effect, in many cases 
depend upon the same principle? It has been sometimes observed', 
that the puncture in the arm has shewn no sign of inflammation in 
fourteen days ufcer the application of the variolous poison. Has 
there not been another disease in the constitution at the time of ino> 



SECT. II. INTRODUCTION. 7 

culation? Does not the cure of some diseases depend upon the 
same principle? The suspension or cure of a gonorrhoea by a fever 
may be an instance of this. 

Let me illustrate this principle still further, by one of many cases 
which have come under my own observation. On Thursday the sixteenth 
of March, one thousand seven hundred and seventy-five, I inoculated 
a gentleman's child; in whose arms it was observed I made large 
punctures. On the Sunday following, he appeared to have received 
the infection; a small inflammation or redness appearing round each 
puncture, and a small tumour above the surface of the skin having 
been observed. On the twentieth and the twenty-first, the child 
was feverish; but I declared that the fever was not variolous, as the 
inflammation had not at all advanced since the nineteenth. On the 
twenty-second, a considerable eruption appeared, which was evidently 
the measles: upon this the sores on the arms appeared to go back, 
becoming less inflamed. On the twenty-third, he was very full of 
the measles; the punctures on the arms being in the same state as on 
the preceding day. On the twenty-fifth, the measles began to dis- 
appear. On the twenty-sixth and twenty-seventh, the punctures 
began again to look a little red. On the twenty-ninth, the inflamma- 
tion increased, and there was a little matter formed. On the thir- 
tieth, he was seized with fever. The small-pox appeared at the re- 
gular time, went through its usual course, and terminated favourably. 
In like manner it may be observed, that the venereal disease makes 
its appearance at different periods after infection. Is not this expli- 
cable on the same principle? 



That two morbid actions cannot go on in the same place at the 
same time, is not only maintained, by the contrary being in opposi- 
tion with common sense; but, at this time is, I believe, admitted, 
from observation, by the general consent of most medical men. 

On the subject of constitutional diseases, the question is more 
doubtful to some, but the very few instances in which two such dis- 
eases have apparently occurred at the same time in the same consti- 
tution, are not sufficient to destroy the general law. 

There are, indeed, two constitutional diseases, or two morbid poi- 
sons, which affect the constitution, and may always be produced at 
the same time in a constitution susceptible of one. But this single 
instance is rather a confirmation of the law. Cow-pox and small- 
pox, if inserted at the same time in different parts of the same per- 
son, produce each the same effect, as if only one of them had been 
inserted. Now, though these two diseases are not exactly the same, 
yet they produce the same change in the constitution, that is, they 
render it no longer susceptible of small-pox. Their action on the 
constitution must, therefore, be in most respects similar, so that we 



g INTRODUCTION. flECT - III# 

might expect them to be carried on in the c^ jfj^f?r 
time. If there are a few solitary instances in which smal -pox or 
cow-pox, and measles, have occurred at the same ime, in h ame 
individual, yet no attempt at producing ^"^^^^ 
time has ever succeeded; and where the measles have^ en ™ 
possession of the constitution, small-pox anoculation has never pro 
duced its effects till the measles have completed their course. The 
proof of this, as given by Mr. Hunter, has been confirmed a the 
Lall-Pox Hospital, and in other places, so often as to render it no 
longer a matter of doubt. 



SECTION III. 

Of the Comparative* Powers of Different Parts of the Body— From 
Situation — From Structure . 

We shall have occasion to observe, that the parts affected assume 
the morbid action more readily, and continue it more rapidly, when 
near to the source of the circulation than when far from it; for the 
heart exerts its influence upon the different parts of the body, in pro- 
portion to their vicinity to it; and the more distant that the parts are, 
the weaker are their powers. 

This is, perhaps, better illustrated by disease than by any actions in 
health; for in health we have no comparative trials, as no two parts 
of the machine, at unequal distances from the heart, can be thrown into 
equal action, and therefore no conclusions can be drawn. It maybe 
observed, that all the vital parts are near the heart. 

In diseases we see mortification, arising from debility, in the ex- 
tremities ofiener than in other parts, more especially if the person is 
tall; the heart not propelling the blood to these distant parts with 
equal force. In such a state of constitution, those who labour under 
a hemiplegia are often found to die at last, from a mortification in the 
extremities of the paralytic side. In some of these cases, the arteries 
give way, and allow of an extravasation of the blood, and therefore 
we may reasonably suppose that they are proportionally weak in 
health. We also find, that such extravasation commonly begins in the 
extremities. This principle is not only evident in these two diseases, 
but also in every disease that can affect an animal body. It appears 
in the readiness with which diseases come on, and proceed in parts 
distant from the source of the circulation, and also in the steps to- 
wards a cure. 

Parts differ not only in their powers, in proportion as they are 
nearer or further from the heart, but likewise according to their pecu- 



SECT. IV. INTRODUCTION. 9 

liar structure, whereby they vary as much in the progress of morbid 
actions as in the operations of health. 

An animal body is composed of a variety of substances, as muscle, 
tendon, cellular membrane, ligament, bone, nerve, &c. We have 
therefore an opportunity of observing the comparative progress of dis- 
eases in them, and their comparative powers of performing a cure; and 
we find that they differ very much from one another in those respects. 
How far these differences take place in all diseases, I have not been 
able to determine; but should suppose, that in specific diseases, as 
scrofula and cancer, there is in general no difference in the mode of 
action in any of the structures,* these diseases producing the same 
specific effects in all the parts that are capable of being affected by 
them ; but in diseases arising from accident, a great difference in 
the degrees of action takes place ; the parts, from such a cause, be- 
ing allowed to act according to their natures ; which observation 
holds good also in the venereal disease. This difference appears to 
be chiefly in the degrees of strength and weakness in resisting mor- 
bid action. The less the natural powers of action are in any parti- 
cular structure of parts, the less they are able to resist disease ; 
therefore bone, tendon, ligament, and cellular membrane, go through 
their morbid actions more slowly than muscle or skin ; and this 
principle is applicable to the venereal disease. 



SECTION IV. 

Of Parts susceptible of Particular Diseases. 

There are some parts much more susceptible of specific diseases 
than others. Poisons take their different seats in the body as if al- 
lotted for them. Thus, we have the skin attacked with what are 
vulgarly called scorbutic eruptions, and many other diseases ; it is 
also the seat of the small-pox and the measles ; the throat is the 
seat of the hydrophobia and the hooping-cough. The scrofula at- 
tacks the absorbent system, especially the glands. The breasts, 
testicles, and the conglomerate glands, are the seat of cancer. The skin, 
throat, and nose, are more readily affected by the lues venerea than 
the bones and periosteum, which, on the other hand, suffer sooner 
than many other parts, particularly the vital parts, which perhaps 
are not at all susceptible of the disease. 

•Here it is to be understood, that we do not include those parts which have 
a greater tendency to specific diseases than what man}' others have; as the 
lymphatics to the scrofula, the breast to the cancer. 

B 



10 INTRODUCTION- SECT. V. 

SECTION V. 

Of Inflammation. 

I consider common inflammation to be an increased action of the 
smaller vessels of a part, joined with a peculiar mode of action, by 
which they are enabled to produce the following effects : to unite 
parts of the body to each other ; to form pus ; and to remove parts 
of the solids. These effects are not produced by a simp e increase 
of action, or enlargement of the vessels, but by a peculiar action, 
which is at present perhaps not understood. 

These three effects of inflammation I have called distinct species 
of inflammation. That which unites parts, I have called the adhe- 
sive inflammation ; that which forms pus, the suppurative inflamma- 
tion ; and that which removes parts, the ulcerative inflammation. 

In the adhesive inflammation, the arteries throw out coagulable 
lymph, which becomes the bond of union. This, however, is not 
simply extravasated, but has undergone some change before it leaves 
the arteries, since, in inflamed veins, it is found lying coagulated 
upon the internal surface of the vessel, which could not have hap- 
pened if simply extravasated. In the suppurative inflammation, a 
still greater change is produced upon the blood before it is thrown 
out by the arteries, whereby it is formed into pus ; which change is 
probably similar to secretion. In the ulcerative inflammation, the 
action of the arteries does not remove the parts ; that office is per- 
formed by the absorbent vessels which are brought into action. 

In the two first species of inflammation, there must be a change 
in the disposition and mode of action of the arteries ; for the suppu- 
rative species cannot be considered as simply an increase of the ac- 
tion of the adhesive, as its effects are totally different ; but in the 
third species there is probably no change of action in the arteries 
from that of the second ; the action only of the absorbents being su- 
peradded, by which solid parts, and of course the arteries them- 
selves, are removed. 



The old idea of inflammation, suppuration, and ulceration, which 
survived the humoral pathology was, that inflammation was excited 
by an obstruction, or, as it was afterwards called, a spasm on the 
extreme vessels — that suppuration was a melting down of the solid 
parts into matter ; and ulceration a continuance of the same process. 
All this was merely describing appearances, and referring them to 
causes which could not produce such effects. We know of no pro- 
cess by which solids can be converted into pus, nor is the destruction 



SECT. V. INTRODUCTION. 11 

of solids necessary for the formation of it ; for we find the purest 
pus where there is no loss of substance, viz. on a granulating sore. 
Mr. Hunter, therefore, considers the coagulated lymph thrown out, 
which was supposed to be the cause of inflammation, as the effect 
only of that process, and not induced merely by extravasation from 
increased action, but by a particular mode of action in order " to 
re-unite parts," in some instances, where they have been divided by 
force, or in cavities, to prevent the spreading of inflammation. This 
is his adhesive inflammation. When the inflammation is so far al- 
tered as to induce a secretion of pus, he calls it suppurative inflam- 
mation ; and when a part of the solid substance is removed by the 
absorbents, whilst the secretion of matter is going on, it becomes the 
ulcerative inflammation. The progress of inflammation is not, in 
every part, according to the order here stated, of adhesive, suppura- 
tive, and ulcerative : when parts are divided and brought into con- 
tact, the adhesive takes place, and, if that succeeds, the inflamma- 
tion ends here ; but if union is not produced by the coagulated 
lymph, a granulating surface must be formed, previous to which 
suppuration and ulceration are necessary, in order to detach the sur- 
face, which was found incapable of union. 

In large cavities containing viscera covered by membranes, if in- 
flammation is excited, the adhesive process is attempted, by which 
surfaces are united, the suppuration of which would be attended with 
much danger. The spreading of the inflammation by continuous 
sympathy is also prevented by this adhesion. If the inflammation 
ceases after the adhesions are formed, no other inconvenience is sus- 
tained than that the parts lose that easy motion on each other which 
conduced much to the performance of their necessary functions. By 
degrees, however, there is reason to believe that these adhesions 
elongate, if they are not altogether absorbed. Such is the case when 
the lungs adhere to the pleura, the heart to the pericardium, and the 
intestines to the peritoneum. But, if inflammation extends further, 
the consequence will be such an alteration in the parts as to prevent 
their returning to their proper functions. Hence the suppurative 
inflammation follows, or the formation of matter. This matter must 
be brought to the surface, or to some outlet, which can only be done 
by the absorption of all the solid matter between the abscess and 
the surface ; and this is the ulcerative inflammation. 

Such is the order of these three inflammations in the parts de- 
scribed, when the inflammatory process does not cease with the ad- 
hesive stage. But, if inflammation attacks a mucous membrane, 
which serves as a passage for any excretion out of the body, the or- 
der is inverted ; for if the first effect of inflammation on such a part 
as these, were to be the throwing out of coagulable lymph in order 
to form adhesions, the consequence would be, that the urethra, the 
vagina, the oesophagus, or any other similar membranes, would be 



12 INTRODUCTION. SECT. VI 

united at their sides, and the necessary passages would be oblitera- 
ted. The immediate consequence of inflammation in such parts, 
therefore, is only an increased and altered secretion. If the inflamma- 
tion is very considerable, the secretion is thin, like the discharge on 
an inflamed ulcer. As inflammation abates, the secretion comes 
nearer to the laudable pus of a healing ulcer. In this state it con- 
tinues lessening in quantity and improving in quality as inflamma- 
tion abates, till at length it returns to its natural form, and for the 
most part to its natural quantity. The period of the last is some- 
what uncertain, as we find gleet remain after the inflammation of 
gonorrhoea has ceased, and an increased discharge will remain in the 
Schniederian membrane and trachea, after the inflammation which 
produced catarrh has subsided. 

Such is the different order of inflammation according to the tex- 
ture and office of the parts inflamed. But as inflammation on a cut 
surface, or on the surface of viscera, or the membrane which lines 
them, may on some occasions prove so violent, or of such a kind, as 
to run immediately into suppuration, so inflammation of mucous 
membranes may be of such a kind, or so violent, as to throw out 
eoagulable lymph, instead of only increasing or altering its usual se- 
cretion. Such is the case in croup, where the trachea, though a mu- 
cous membrane, throws out eoagulable lymph under inflammation. 
Such Mr. Hunter found he could induce in the vagina of an ass, by 
injecting a strong solution of corrosive sublimate. Perhaps such are 
the few instances in which what are called caruncles have been 
found in the urethra.* M. Bichat, without knowing what was done 
by Mr. Hunter, has made an ingenious work on the different forms 
of inflammation, according to the texture of the membranes inflamed. 
Abstracted from the French verbiage, the whole is reducible to those 
laws of inflammation which Mr. Hunter has so long taught, and of 
which, in two instances, an epitome is here offered. 



SECTION VI. 

Of Mortification. 

Mortifications are of two kinds, the one preceded by inflamma- 
tion, the other not ; but as the cases of mortifications, which will be 
mentioned in this work, are all of the first kind, I shall confine my 
observations to that species. 

I consider inflammation as an increased action of that power which 

• Even in these cases, however, nature seems to have made a provision, that 
though coagulated lymph is thrown out, yet it shall not unite the sides of ca 
aais, as it does viscera, with their surrounding membranes 



-SECT. VI. INTRODUCTION. 13 

a part is naturally in possession of. This increased action, in healthy 
inflammations at least, is probably attended with an increase of 
power ; but in inflammations which terminate in mortification, there 
is no increase of power : on the contrary, there is a diminution of 
power, which, joined to an increased action, becomes the cause of 
mortification, by destroying the balance which ought to subsist be- 
tween the power and action of every part. 

If this account of mortifications be just, we shall find it no diffi- 
cult matter to establish a rational practice ; but before we attempt 
this, let us just take a view of the treatment hitherto recommended 
and see how far it agrees with our theory. 

It is plain, from the common practice, that the weakness has been 
attended to; but it is as plain, that the increased action has been over- 
looked ; and therefore the whole aim has been to increase the action 
with a view to remove the weakness. The Peruvian bark, confectio 
cardiaca, serpentaria, &c. have been given in as large quantities as 
the case appeared to require, or the constitution could bear ; by 
which means an artificial or temporary appearance of strength has 
been produced, while it was only an increased action. The cordials 
and wine, upon the principle on which they have been given, are 
rationally administered ; but there are strong reasons for not recom- 
mending them, arising from the general effect which all cordials 
have of increasing the action without giving real strength ; and the 
powers of the body are afterwards sunk proportionally as they have 
been raised ; by which nothing can be gained, but a great deal may 
be lost ; for in all cases, if the powers are allowed to sink below a 
certain point, they are irrecoverable. 

The local treatment has been as absurd as the constitutional. 
Scarifications have been made quite to the living parts, that stimulat- 
ing and antisceptic medicines might be applied to them, such as 
turpentines, the warmer balsams, and sometimes the essential oils. 
Warm fomentations have been also applied as congenial to life ; but 
warmth always increases action, and stimulants are improper where 
the actions are already too violent. 

Upon the principles here laid down, the bark is the only medicine 
that can be depended upon, as it increases the powers and lessens 
the action. Upon many occasions opium will be of singular service, 
by lessening the action, although it does not give real strength. I 
have seen good effects from it, both when given internally in large 
doses, and when applied to the part. To keep the parts cool is pro- 
per ; and all the applications should be cold. The above-mentioned 
practice is to be kept in view in mortifications that happen in the 
venereal disease. 

Inflammation, we have seen, is not merely increased action, but 
also a new mode of action governed by certain laws. To support 



14 INTRODUCTION. SECT. VI. 

this increased action, and to change the mode of action according to 
the new circumstances of the part, all the vessels connected with the 
part must possess a power equal to the new offices required, and the 
constitution must possess strength to maintain the parts in the use of 
such power. If the parts are distant from the source of the circula- 
tion, or if they are, from the nature of their texture, but scantily 
supplied with blood-vessels, the probability is, that, when inflamed, 
the inflammation will not run high. Should the inflammation be 
very considerable, there will be danger lest the action may prove 
greater than the parts can support, or than the constitution can main- 
tain them under. In this case, the parts must cease to act altogether, 
or, in other words, mortification must follow. This is easily illus- 
trated by what we see occur in the actions of those parts which are 
more immediately the object of our senses. Every animal has a cer- 
tain power of muscular action, and every man has certain reasoning 
powers. Action seems, if not necessary, at least useful, for both ; 
but either of them may, for a time, support an action which, if con- 
tinued beyond a certain degree, will destroy either life or the organ 
whose action has been too long increased. A horse will feel that 
high animation which will enable him to go over a quantity of 
ground greater than he could accomplish at other times ; but if this 
extraordinary action is kept up too long, the consequence is the death 
of the animal. In the rational part of man, if action is kept up 
longer than the reasoning powers can support, the consequence is 
sometimes fatuity altogether. Mr. Hunter used to produce a still 
better illustration to show the consequence of exciting action, beyond 
what the powers of the animal would support. He kept lizards and 
other reptiles in a cool cellar without food till late in the spring. In 
this condition they crawled slowly about, but were for the most part 
motionless, without being completely torpid. On exposing some of 
tin. m to a warm sun they instantly became lively, and basked in the 
rays ; but in a few hours after ceased to live altogether. In the 
mean time, those which remained in the cellar retained their life 
and former habits. In the first, action was suddenly excited without 
the power of supporting it : in the second, action remained languid 
in proportion to the powers. 

The frost-bitten affords another illustration of the necessity of 
power to support action before the latter is excited. If the affection 
extends throughout the whole frame, and the person is suddenly 
brought to a strong heat, the consequence is, that high action is ex- 
cited in some organs before others are so far relieved as to assist in 
supporting that action, and death follows. If only a part is frozen 
the same danger attends the sudden application of warmth to that 
part, for if full action is at once excited before the neighbouring ves- 
sels are brought into a situation to support that action, the part dies. 
This is so universally understood in very cold climates, that the con- 



SECT. VI. INTRODUCTION. 15 

stant practice is to rub with snow a person or part frozen before any 
heat is applied. By this friction, action is gradually excited, and 
by the coldness of the snow that action is kept under. 

Mortification, however, is not a mere cessation of action : it seems 
to be the last sequel of inflammation, when it can neither be arrested 
by adhesion nor suppuration ; for a dead part of a man who has died 
from any common disease, shows, as far as we can judge, the same 
arrangement of vessels as existed during life, and the only difference 
we know of is, that action has ceased and cannot be restored. But 
in a mortified part we find no vessels, nor any distinction of parts : 
all appears an homogeneous mass, which no means can restore to its 
former functions. The next process of nature is, therefore, to sepa- 
rate it from its attachment to the living part. In order to assist the 
constitution, it is plain that we are not to excite high action. We 
have already seen, that an increase of action beyond what the 
strength will support, has been followed by mortification. Our at- 
tention must be directed to increasing strength, which would be fur- 
ther impaired by too much action. With sufficient strength, the 
parts will act according to those laws impressed upon them by their 
new situation, that is, ulceration will commence in order to dislodge 
the dead part. This ulceration, we have before shown, is no more 
than absorption with the secretion of pus. Absorption of the sub- 
stance, by which the mortified is connected with the living part, is 
the only means of what is called separation, which we look for after 
mortification. To produce this, a certain degree of power is neces- 
sary ; but high action is inconsistent with the action we look for, 
and destructive of the power which is to support it. 



16 OF THE VENEREAL POISON. CHAP. I. 



PART I. 



CHAP. I. 

Of the Venereal Poison. 

The venereal disease arises from a poison ; which, as it is pro- 
duced by disease, and is capable of again producing a similar disease, 
I call a morbid poison, to distinguish it from the other poisons, ani- 
mal, vegetable, and mineral. 

The morbid poisons are many, and they have different powers of 
contamination. Those which infect the body, either locally or con- 
stitutionally, but not in both ways, I call simple. Those which are 
capable of affecting the body both locally and constitutionally, I call 
compound. The venereal poison, when applied to the human body, 
possesses a power of propagating or multiplying itself; and as it is 
all capable of acting both locally and constitutionally, it is a com- 
pound morbid poison. Like all such poisons, it may be communi- 
cated to others in all the various ways in which it can be received, 
producing the same disease in some one of its forms. 

Mr. Hunter is the first person who saw the necessity of appropriating 
different terms to the different kinds of animal poisons. Dr. Mead, 
and indeed most of the writers on hydrophobia, confounded that poi- 
son with the poison of venomous reptiles. But it is scarcely neces- 
sary to remark, that such animals as have originally a poison for at- 
tack or defence, are always found to be more venomous in propor- 
tion as they are in better health ; and the animals poisoned by them 
acquire no power of poisoning others. On the contrary, as far as 
we have been able to ascertain the fact, though the dog may not have 
all the symptoms of rabies when his bite induces hydrophobia in other 
animals, yet he is never in health, and many of the animals thus bit- 
ten acquire the property of inducing a similar disease in others. 
Hence the poison, being the effect of disease, is very properly called 
morbid. For the same reason the venereal disease, the small-pox, 
and some others, are morbid poisons ; these can only be excited by 
the application of matter produced from the respective diseases • 
they must, therefore, have originated from some cause we cannot 
now trace. 



CHAP. I. OF THE VENEREAL POISON. 17 

By this section it would appear, that Mr. Hunter suspected the 
venereal poison owed its origin to some unnatural connexion. The 
probability of this is in some degree confirmed by what we see of 
the cow-pox. This morbid poison certainly originates from a quad- 
ruped; yet when assumed by man, may uniformly be communicated to 
any extent. The great analogy between this morbid poison and 
small-pox leads us fairly to conclude, that the latter also was derived 
from some other animal, and perhaps the tradition concerning the 
camel may have some foundation. It is certain that the vaccine virus 
in the cow does not exhibit exactly similar phenomena to what we 
see in the human. In the latter, the local disease excited never pro- 
duces any secretion, excepting lymph, or at least a transparent fluid. 
In the cow I have never seen such a secretion. In all the instances 
I have heard of, and in the only instances in which I saw the disease, 
in company with Dr. Jenner, when it pervaded a large dairy in Glou- 
cestershire, it was in all the cows that were examined, turbid like pus 
slightly tinged with brownish red. Yet this pus induced, in innumer- 
able successions, on the human arm, vesicles filled with a transparent 
fluid, and which never became purulent throughout the whole pro- 
cess, from vesication to scabbing and cicatrization: nor was it possi- 
ble to distinguish between those arms which were infected immedi- 
ately from the cow, and these which were inoculated from the human 
subject. The blue appearance so much talked of occured in both, 
and in both the complexion of the different vesicles varied from the 
blue to the pale amber. But in all it proved a true poison to those 
who were susceptible of its impression. 

There is, indeed, every certainty the nature of the case will admit, 
that all the morbid poisons are of late origjn, and the exact period of 
the venereal poison is now pretty well ascertained; and as at this 
time none of the morbid poisons can be excited but by the application 
of such poisons in some form, this is alone a sufficient proof that their 
origin must be looked for in some event different from the customary 
communication between animals of the same species. 

On this occasion, I cannot help remarking the coincidence of lan- 
guage between Dr. Jenner and myself, without any previous know- 
ledge of each other's writing; for the first edition of" Morbid Poisons" 
was published three years before Dr. Jenner's great discovery, yet 
his retired mode of life prevented his knowing that such a work ex- 
isted. Dr. Jenner is bolder in his conjectures, but in other respects 
the similarity of our sentiments may amuse some of my readers. 

" Diseases in one class of animals, when communicated to another, 
seem to alter many of their properties. It has not yet been exactly 
ascertained what is the peculiar situation of the dog, or other rabid 
animal, when his bite produces hydrophobia. Certain it is, that the 
same symptoms have not uniformly appeared as have followed his 
bite. The cow-pox is a disease well known among the farmers of 

c 



IS OF THE VENEREAL POISON. SECT. I- 

Gloucestershire, &c. Whether any of the morbid poisons which at 
present so much diminish the period of human life, arose irornsucli 
causes, cannot now be determined."— Morbid Poisons, first edition, 

1795 p 155 6 
Dr. Jenner''s work, which was published in 1798, commences 

thus: ,.ii • • li 

"The deviation of man from the state in which he was originally 
placed by Nature seems to have proved to him a prolific source ol 
diseases. From the love of splendour, from the indulgences of luxu- 
ry, and from his fondness for amusement, he has familiarized him- 
self with a great number of animals, which may not originally have 
been intended for his associates." 

Let it not be suspected, from the above Quotation, that I claim any 
part of Dr. Jenner's discovery, by rraving published before him. 
My only knowledge of cow-pox was derived from Mr. Cline, who, in 
answer to my suggestion of the probable origin of morbid poisons, 
acquainted me with Dr. Jenner's labours. 



SECTION I. 

Of the First Origin of the Poison. 

Though the first appearance of this poison is certainly within the 
period of modern history, yet the precise time and manner of its 
origin has hitherto escaped our investigation; and we are still in 
doubt, whether it arose in Europe, or was imported from America. 
I shall not attempt to discuss this question; and those who wish to 
examine at length the facts, authorities, and arguments brought in 
favour of the latter opinion, may consult Astruc; and for the former 
a short treatise*, published in one thousand seven hundred and fifty- 
one, without a name. The author of this treatise appears to have 
considered the subject very fully, and as far as reasoning goes on a 
subject of this kind, proves that the disease was not brought from the 
West Indies. Not contented with this, he goes on to account for its 
first rise in Europe; but in this he is not equally successful. The 
subject is a difficult one; and the want of a sufficient number of facts 
leaves too much room for conjecture. 

We shall not therefore enter further into this question; nor is it 
material to know at what period, and in what country, this disease 

• Intitled, " A Dissertation on the Origin of the Venereal Disease ; proving that 
it was not brought from America, but began in Europe from an epidemical dis- 
temper. Translated from the original Manuscript of an eminent Physician. 
London, printed for Robert Griffiths, 1751." 



SECT. II. OP THE VENEREAL POISON. 19 

arose; but we may in general affirm, that as animals are not natu- 
rally formed with disease, or so as to run spontaneously into morbid 
actions; but with a susceptibility of such impressions as produce such 
actions, diseases must always arise from impressions made upon the 
body: and as man is probably susceptible of more impressions, that 
become the immediate cause of disease, than any other animal, and 
is besides the only animal which can be said to form artificial im- 
pressions upon himself, he is subject to the greatest variety of dis- 
eases. In one of those self- formed situations, therefore, the impres- 
sion most probably was given, which produced the venereal disease. 



SECTION II. 

It began in the Human Race, and in the Parts of Generation. 

In whatever manner it arose, it certainly began in the human race; 
as we know no other animal that is capable of being infected with 
this poison. It is probable, too, that the parts of generation were the 
first affected; for, if it had taken place in any part of the body, it 
might probably never have gone further than the person in whom it 
first arose, and therefore never have been known; but, being seated 
in the parts of generation, where the only natural connection takes 
place between one human being and another, except that between the 
mother and child, it was in the most favourable situation for being 
propagated: and, as we shall find hereafter in the history of the dis- 
ease itself, that no constitutional effect of this poison can be commu-' 
nicated to others, we are led of necessity to conclude that its first 
effects were local. 



The secondary or constitutional effect of small-pox, or of cow-pox, 
in the few instances in which secondary vesicles appear in the latter, 
have all the same properties as the primary, and only differ in size. 
The fluid taken from them also is similar, and will induce a similar 
disease in another person. But in the venereal disease the secondary 
symptoms have no resemblance to the primary. The appearance, as 
well as the progress of the chancre, is quite different from the copper 
spot, and subsequent slow ulceration of the skin ; as will be hereafter 
shown in the order of the work. 



20 OF THE VENEREAL POISON. CHAP. I« 

SECTION III. 

Of the Nature of the Poison. 

We know nothing of the poison itself, but only its effects on the 
human body. It is commonly in the form of pus, or united with pus, 
or some such secretion, and produces a similar matter in others, 
which shows that it is most generally, although not necessarily, a 
consequence of inflammation. It produces, or excites, therefore, 
in most cases, an inflammation in the parts contaminated; besides 
which inflammation, the parts so contaminated have a peculiar mode 
of action superadded, different from all other actions attending in- 
flammation; and it is this specific mode of action which produces 
the specific quality in the matter. It is not necessary that inflam- 
mation should be present to keep up this peculiar mode of action, 
because the poison continues to be formed long after all signs of in- 
flammation have ceased. This appears from the following facts: 
men having only what is called a gleet or healing chancre, give the 
disease to sound women; and many venereal gonorrhoeas happen 
without any visible signs of inflammation. 

In women the inflammation is frequently very slight, and often 
there is not the least sign of it; for they have been known to infect men 
though they themselves have had no symptoms of inflammation, or of 
the disease in any form. Therefore the inflammation and suppuration, 
when prssent, are only attendants on the peculiar mode of action: 
the degree in which they take place depending more on the nature of 
the constitution than on that of the poison. 

The formation of matter also, though a very general, is not a con- 
stant attendant on this disease; for we sometimes find inflammation 
produced by the venereal poison, which does not terminate in suppu- 
ration; such inflammation I suspect to be of the erysipelatous kind. 
It is the matter produced, whether with or without inflammation 
which alone contains the poison; for without the formation of mat- 
ter, no venereal poison can exist. Therefore a person having the 
venereal irritation in any form, not attended with a discharge, cannot 
communicate the disease to another. To communicate the disease 
therefore, it is necessary that the venereal action should first take 
place; that matter should be formed in consequence of that action- 
and that the matter should be applied to a sound person or part. 

That the venereal disease is to be propagated only by matter is 
proved every day by a thousand instances. Married men contract 
the disease, and not suspecting that they have caught it, cohabit with 
their wives, even for weeks. Upon discovering symptoms of the 
disease, they of course desist; yet in all my practice I never once 



SECT IV. OF THE VENEREAL POISON. 21 

found, that the complaint was communicated under such circum- 
stances, except where they had not been very attentive to the symp- 
toms, and therefore continued the connection after the discharge had 
appeared. I have gone so far as to allow husbands, while infected, 
but before the appearance of discharge, to cohabit with their wives, 
in order to save appearances, and always with safety. I could carry 
this still further, and even allow a man, who has a gonorrhoea, to 
have connection with a sound woman, provided that great care be 
taken to clear all the parts of any matter, by first syringing the ure- 
thra; making water; and washing the glans. 

The matter, which is impregnated with this poison, when it comes 
in contact with a living part, irritates that part, and inflammation is 
the common consequence. It must be applied either in a fluid state, 
or rendered fluid by the juices of the part to which it is applied. 
There is no instance where it has given the infection in the form of 
a vapour, as is the case in many other poisons. 



SECTION IV. 

Of the greater or less Acrimony of the Poison. 

Venereal matter must in all cases be the same; one quantity of 
matter cannot have a greater degree of poisonous quality than ano- 
ther; and if there is any difference, it is only in its being more or 
less diluted, which produces no difference in its effects. One can 
conceive, however, that it may be so far diluted as not to have the 
power of irritation. Thus any fluid taken into the mouth, capable 
of stimulating the nerves to taste, may be so diluted as not to be 
tasted. But if the poison can irritate the part, to which it is appli- 
ed, to action, it is all that is required; the action will be the same, 
whether from a large or small quantity, from a strong or a weak so- 
lution. 

We find, from experience, that there is no difference in the kind 
of matter; and no variation can arise in the disease from the matter's 
being of different degrees of strength; for it appears, that the same 
matter affects very differently different people. Two men having 
been connected with one woman, and both catching the disease, one 
of them shall have a violent gonorrhoea or chancre, while the other 
shall have merely a slight gonorrhoea. I have known one man give the 
disease to different women, and some of the women have had it very 
severely, while in others it has been very slight. The same reason- 
ing holds good with regard to chancres The variations of the symp- 



22 OF THE VENEREAL POISON. CHAP. U 

toms in different persons depend upon the constitution and habit of 
the patient at the time. What happens in the inoculation of the 
small-pox strengthens this opinion. Let the symptoms of the pa- 
tient, from whom the matter is taken, be good or bad; let it be from 
one who has had a great many pustules, or from one who has had but 
few; let it be from the confluent or distinct kind; applied in a large 
quantity or a small one; it produces always the same effect. This 
could only be known by the great numbers that have been inoculated 
under all these different circumstances. 

. As far as Mr. Hunter's illustration required, he is perfectly correct; 
for in small-pox matter applied in quantities, however small or great, 
however numerous the punctures of inoculation, or however large the 
quantity of matter thrown into the puncture, the effect is the same as 
if the punctures were fewer, and the matter diluted with water to 
any quantity not sufficient to render it effete. The opinion of Dr. G. 
Fordyce that the advantage derived from inoculation arises from the 
small quantity of matter introduced, produced only a temporary ef- 
fect on the practice, and was refuted by every observation. It is 
not so certain that the acrimony of the poison may not be different, 
and that such difference may not be permanent. It is hardly con- 
ceivable that the cow-pox is not a milder small-pox, the character 
of which may be perpetuated. On this subject I have entered more 
at large in " Morbid Poisons," and as the question is not necessary 
to be resolved in this place, I shall leave it to future experience. 



SECTION V. 

Of the Poison being the same in Gonorrhoea and in Chancre. 

It has been supposed by many, that the gonorrhoea and the chan- 
cre arise from two distinct poisons; and their opinion seems to have 
some foundation, when we consider only the different appearance of 
the two symptoms, and the different methods of cure; which, with 
respect to the nature of many diseases, is too often all we have to 
lead our judgment. Yet, if we take up this question upon other 
grounds, and also have recourse to experiments, the result of which 
we can absolutely depend upon, we shall find this notion to be er- 
roneous. 

If we attend to the manner in which the venereal poison was com- 
municated to the inhabitants of the islands of the South Seas, there 



«£CT. V. OP THE VENEREAL POISON. 23 

are many circumstances which tend to throw light upon the present 
question. It has been supposed, as no mention is made of a gonorr- 
hoea at Otaheite, that it must have been the chancre that was first 
introduced into that island; and that of course nothing but a chan- 
cre could be propagated there; for as no gonorrhoea had been com- 
municated, no such disease could take place. But if we were to rea- 
son upon all the probable circumstances attending the voyages to 
that part of the world, we should conclude the contrary; for it was 
almost impossible to carry a chancre so long a voyage without its 
destroying the penis; while we know from experience, that a gonorr- 
hoea may continue for a great length of time. It is mentioned in 
Cook's voyage, that the people of Otaheite, who had this disease, 
went into the country and were cured; but when it became a pox, 
it was then incurable. This shows, that the disease which they had 
must have been a gonorrhoea; for we know that it is only a gonorr- 
hoea that can be cured by simple means: and further, if it had been 
a chancre, and they had been acquainted with the means of curing it, 
they could also have cured the lues venerea. 

Wallis left Plymouth in August 1766, and arrived at Otaheite in 
July 1767, eleven months after his embarkation; and if none of his 
men had the disease when he sailed, there was hardly a possi- 
bility of their contracting it any where afterwards in the voyage. 
This appears to be too long for a gonorrhoea to last. But let us sup- 
pose even that Wallis carried it thither in his ship, one or two of his 
crew having the disease. As he staid there five weeks, it was very 
possible, even very probable, that such person or persons might have 
communicated it so quickly as to have become the cause of contami- 
nation of the whole crew of his ship; but as this did not happen, 
it is a presumptive proof that Wallis did not carry it thither. 

Bougainville left France in December 1766, but he touched at 
several places where some of his people might have got the disease. 
The last of which place was Rio de la Plata, which he left in Novem- 
ber 1767, and arrived at Otaheite in April 1768, five months after- 
This interval of time agrees better with the usual continuance of the 
disease, than the length of Wallis's voyage, and therefore from this 
circumstance it becomes more probable, that Bougainville had car- 
ried it thither. Besides, it is likely that he could guard his people 
less against the disease than Wallis; for Wallis could have his choice 
of men at his first setting out, which was all that was necessary to 
prevent his carrying the disease with him, for he ran no risk of con- 
tracting it afterwards: but although Bougainville had the sarne ad- 
vantage at first, yet he had it not afterwards, for his men were in the 
way of infection in several places, and he had no opportunity of chang- 
ing them, and probably no great chance of having them cured. The 
circumstance of the disease being found by Bougainville at Otaheite 



24 OF THE VENEREAL FOISON. CHAP. f< 

soon after his arrival, is a kind of proof that he carried it thither 
himself; for I observed before, that if Wallis had carried it bj one 
man only, this man could in a very few days have so far propagated 
it, as to have spread it through the whole ship's crew; and as Bou- 
gainville arrived at the island ten months after Wallis, there was a 
sufficient time for the inhabitants of the whole island to have been 
infected, and the ravages of the disease must have been evident to 
them immediately upon their arrival. Bougainville remained only 
nine days at the island of Otaheite, and observed nothing of the dis- 
ease till some weeks after his departure, when it was found that se • 
veral of the crew were infected, which most probably must have 
happened in consequence of the poison being carried there by some 
of his own people. It is also mentioned by Cook, that the Otaheite- 
ans ascribed the introduction of the disease to Bougainville; and we 
can hardly suppose that they would be so complaisant to our country- 
men as to accuse Bougainville, when they must have known whether 
the disease was imported by Wallis or not, especially as they had 
no reason to be partial in favour of the people who accompanied the 
latter. But as we find in Cook's last voyage, that the disease in 
every form is now there, and as we have no new intelligence of a 
gonorrhoea being since introduced, we must suppose that every form 
of the disease has been propagated from one root, which most pro- 
bably was a gonorrhoea. 

If any doubt still remain with respect to the two diseases being of 
the same nature, it will be removed by considering that the matter 
produced in both is of the same kind, and has the same properties; 
the proofs of which are, that the matter of a gonorrhoea, a chancre, 
or the lues venerea; and the matter of a chancre will also produce 
either a gonorrhoea, a chancre, or the lues venerea. 

The following case is an instance of a gonorrhoea producing a lues 
venerea. A gentleman twice contracted a gonorrhoea, of which he 
was cured both times without mercury. About two months after 
each, he had symptoms of the lues venerea; those in consequence of 
the first infection were ulcers in the throat, which were removed by 
the external application of mercury; the symptoms, inconsequence 
of the second, were blotches on the skin, for which also he used the 
mercurial ointment, and was cured. With regard to the lues vene- 
rea proceeding from chancres, instances occur so frequently to every 
one's observation, as to require no further proof here. 

Since then it appears, that the gonorrhoea and chancre are the ef- 
fects of the same poison, it may be worthy of inquiry, to what cir- 
cumstances two such different forms of the disease are 'owin°\ 

To account for these two very different effects of the same poi- 
son, it is only necessary to observe the difference in the mode of ac- 
tion of the parts affected when irritated, let the irritation be what it 



SECT. V. OP THE VENEREAL POISON. 25 

may. The gonorrhoea always proceeds from a secreting surface,* 
and the chancre is formed on a non-secreting surface; and in this 
last the part to which the poison is applied, must become a secreting 
surface before matter can be produced. All secreting surfaces in the 
body being probably similar, one mode of application only is neces- 
sary to produce this disease in them all, which is by the poisonous 
matter simply coming in contact with them. But to produce the 
chancre, the venereal matter may be applied in three different ways; 
the first and most certain is by a wound, into which it may be intro- 
duced; the second is by applying the matter to a surface with a cu- 
ticle, and the thinner that is it allows the matter to come more rea- 
dily to the cutis; and the third is by applying the matter to a com- 
mon sore already formed. 

The poison then being the same in both cases, why do they not 
always happen together in the same person ? For one would natu- 
rally suppose, that the gonorrhoea, when it has appeared, cannot fail 
to become the cause of a chancre; and that this, when it happens 
first, must produce a gonorrhoea. Although it does not often happen 
so, yet it sometimes does; at least there is great reason to believe so. 
I have seen cases where a gonorrhoea came on; and in a few days 
after in some, in others as many weeks, a chancre has appeared: 
and I have also seen cases where a chancre has come first; and in 
the course of its cure, a running and pain in making water have 
succeeded. It may be supposed that the two diseases arose from the 
original infection, and only appeared at different times; and their not 
occurring oftener together would almost induce us to believe it was 
so, since the matter is the same in both, and therefore capable of pro- 
ducing either the one or the other. 

I suspect that the presence of one irritation in these parts becomes 
in general a preventive of the other. I have already observed, that 
the two parts sympathize in their diseases; and it is possible that that 
very sympathy may prevent the appearance of the real disease; for 
if an action has already taken place which is not venereal, it is im- 
possible that another should take place till that ceases; and it is pro- 
bable that this sympathy will not cease while the cause exciting it 
exists; and therefore when both happen in the same person at the 
same time, I suspect that either the urethra *iever had sympathized 

* By secreting surfaces I mean all the passages for extraneous matter, includ- 
ing also the ducts of glands, such as the mouth, nose, eyes, anus, and urethra; 
and by non-secreting surfaces, the external skin in general. To which 1 may add a 
third kind of surface leading from the one to the other, as the glans penis, prola- 
bium of the mouth, the inside of the lips, the pudendum ; which surfaces, 
partaking of the properties of each, but in a less degree, are capable of be- 
ing affected in both ways, sometimes by being excited to secretion, and at 
other times to ulceration. 



26 OF THE VENEREAL POISON. CHAP- I 

with the chancre, or if it did at first, that the sympathy had ceased 5 
and then the venereal matter might stimulate the parts to action. 

We shall, hereafter, consider more at large the cause of this differ- 
ent appearance of the same disease in two different parts. At pre- 
sent I shall only take notice, that, with the best informed men, this is 
by no means the only objection to the admission that gonorrhoea and 
chancre arise from the same poison. 

It is urged with much truth, that there are many instances of the 
perpetuation of a gonorrhoea through several subjects, without pro- 
ducing either chancres or secondary venereal symptoms in any of 
them. But this reasoning would only lead to the admission that the 
particular gonorrhoea thus instanced, though infectious, was not ve- 
nereal. That gonorrhoea may be infectious, without being venereal, 
can hardly be questioned. As early as the promulgation of the Le- 
vitical law, it was required, that a man having a running at the 
reins, or, as the Septuagint has it, yovoppot*^ should be restrained from 
those connections by which he might communicate the disease; yet 
at this time there is no one who will undertake to prove that the ve- 
nereal disease was known before the siege of Naples. When that 
disease excited the greatest terror, the first symptoms were almost 
overlooked. As they became better understood, and the source of 
them was traced to the genitals, it was still not easily suspected that 
a new disease could be traced from a symptom so long known as go- 
norrhoea. Some striking case, probably, gave the first suspicion, 
which was no sooner confirmed, than some systematic writers began 
to consider gonorrhoea as the necessary forerunner even of chancre: 
and with others, every gonorrhoea was considered venereal. 

I shall at present pass over the argument drawn from the South Sea 
expedition, because, fortunately, it is not necessary to prove the ques- 
tion, and for other reasons which will hereafter appear. Indeed, 
when Mr. Hunter had so many proofs that the two forms of the dis- 
eases might be excited by the same matter, we cannot but lament he 
should have attempted an inference from data so ill-established as the 
South Sea disease. 

Mr. Hunter's subsequent experiment, which will occur hereafter, 
puts this question beyond a doubt. I shall here relate only one case^ 
the circumstances and parties connected with which afford also a 
very good illustration of some peculiarities in the mode of infec- 
tion. 

A young woman, who, though not on the town, was pretty liberal 
in her favours, was remarked to be very conscientious in not admit- 
ting any connection with married mem She had intercourse with 
many who were not delicate in their amours, till she became fixed in 
the house of a bachelor surgeo nW This gentleman, naturally of a de- 



SECT. V. OF THE VENEREAL POISON. 27 

licate constitution, had been for some time in a reduced state of 
health, during which he was nursed by the above female with much 
attention. The consequence of his convalescence may be easily 
guessed. Soon after this, he asked my opinion of some suspicious 
ulcers on the glans penis which had every character of chancres. 
What surprised him the most was, that the girl with whom only he 
had had any connection since his tedious illness appeared in perfect 
health, and he could ascertain with a certainty that she had no chan- 
cres. It was however discovered, that she had had, for a longer time 
than could be well ascertained, a discharge from those parts by 
which some of her lovers suffered, though others escaped, probably 
in proportion as the parts of each were more or less habituated to the 
poison; and, perhaps, the surgeon might owe his greater suscepti- 
bility to his chastity during his previous illness. The fact, however, 
shows two things; first, that gonorrhoea virulenta may exist with so 
little inflammation, and perhaps so slight a discharge, as to be scarcely 
known by the patient; and secondly, that in this state the discharge 
may excite ulceration or chancres in another person. 

By this section we are led to inquire, why the same cause shall 
produce a different effect according to the nature of the parts to which 
it is applied. We have seen in the introduction (see pages 11 and 12), 
that common inflammation, from whatever cause, differs in its effects 
according to the customary actions, or, as it is sometimes said, ac- 
cording to the texture of the parts on which it is excited. The first 
process of inflammation on many surfaces there described we saw was 
adhesion. If inflammation had run particularly high, or the cause 
which excited it continued, we saw that the next process would be 
suppuration- In the venereal action the inflammation is not consi- 
derable, but the cause continues after the adhesions are formed: the 
consequence, therefore, must be suppuration, the peculiar phenomena 
of which in chancre we shall explain in its place. 

But if the cause which excites inflammation should continue to 
exist on a secreting surface, the consequence, We have seen, is, that 
suppuration, or the secretion of pus, will take place by a mere change 
in the secretion of that surface. The analogy, therefore, holds good 
in the application of the venereal virus, which is one mode of excit- 
ing inflammation. Nor is it confined to this morbid poison. 

In the small-pox taken in the casual way, the poison is applied to 
every part of the body; and if the inflammation is considerable, every 
part acts according to those functions with which it is invested. The 
skin and cellular substance, not being mucous membranes, are in- 
flamed; coagulable lymph is thrown out; a slough follows, deep or 
shallow according to the violence of the inflammation: suppuration is 
the consequence, with ulceration to detach the slough: — such is the 
process in the external surface. In the cavities of the brain, an in- 
creased secretion takes place. Between the dura mater and brain, 



28 OF THE VENEREAL POISON- CHAP. I» 

lymph is thrown out, and, if the inflammation is very high, adhe- 
sions follow. In various parts of the abdomen, the same process is 
going on; but on the mucous membranes, if attacked with inflamma- 
tion, the only consequence is increased secretion. Hence salivation 
takes place at the fauces, whilst suppuration is commencing on the 
surface. That the secretion arises from the same cause, and has the 
same virulent properties in each, is evident by the period that it lasts, 
and by the effects of each when applied to another person susceptible 
of the disease. In the Small-Pox Hospital, we have inoculated se- 
veral persons with the saliva, and others with the fluid from a small- 
pox pustule, and found precisely the same effects. 

Having thus, I hope, sufficiently illustrated Mr. Hunter's explana- 
tion, how the same matter applied to different surfaces may produce 
different effects, the reader must indulge me with a few words on the 
South Sea disease. 

About the year 1800, a lady of fashion who was recommended to 
my care in Madeira, brought with her the French account of De la 
Peyrouse's voyage. Though I had leisure enough to peruse the 
whole, yet the letters of his surgeon attracted my particular notice. 
After examining them with the greatest attention, I could not help 
remarking that he wrote of mals veneriennes without the precision of a 
Hunter. In the end, I was convinced there was reason to doubt 
whether De la Peyrouse's surgeon had met with the venereal disease 
in any of the places in which he spoke of it with so much freedom. 
This induced me to examine the accounts of Captain Cook's voyages; 
and the result was, a thorough conviction, that, if the venereal dis- 
ease existed at all in the South Sea islands, there was at least no sa- 
tisfactory proof of it. Under this impression, I wrote to three phy- 
sicians in London, explaining my doubts, and, perhaps with more 
Quixotism than prudence, was willing, if encouraged, to make a voy- 
age in order to ascertain a point involving not only an important me- 
dical question, but in some measure the national reputation. 

Fortunately this question has been much better decided, by one 
who candidly admits his arrival at those islands with a most per- 
fect conviction that the disease existed there in all its forms. His in- 
quiry was not, therefore, whether he should find it, but how general 
and with what severity, it would appear, and also how he might pre- 
serve the health of his crew. From these circumstances, and still 
more from the character of the gentleman, no doubt can be enter- 
tained of the faithfulness of his conclusion, which is, that " the ve- 
nereal disease is unknown in Otaheite."* At first sight, it may seem 

• "From the foregoing statement," says Mr. Wilson, « it m ay be conclud- 
ed, without, I hope presuming too much, that, notwithstanding the melancholy 
accounts we read of the ravages of lues venerea at Otaheite, and even dispX 
tations about its first importers, tins disease was not introduced there antece 



SECT. VI. OF THE VENEREAL POISON. 29 

strange that this opinion of mine has never been published before the 
fact was confirmed by Mr. Wilson. To this I can only answer, that to 
offer an opinion on a subject without the means of ascertaining it, 
must, at least, be premature. There are, however, fortunately, wit- 
nesses that such was my opinion. Dr. Garthshore is one of the gen- 
tlemen to whom I wrote from Madeira on the subject. The late Dr. 
Pitcairn was another, which is confirmed by his note now in my pos- 
session, and also by a communication he made to a most distinguished 
philosophical character now living. 

But perhaps it may be asked, " Admitting the whole as I have stated 
it, why should the reader be troubled with the account?" In order, I 
answer, that he may learn there are certain characters by which the 
venereal disease maybe distinguished with certainty; that these are 
so well marked as to be understood by description; and that even the 
absence of them may be ascertained by those who take the trouble of 
examining with sufficient diligence. It may, then, be asked, how 
could the accurate Hunter have fallen so easily into the belief, that 
the venereal disease was known in all its forms in the South Sea isl- 
ands? Mr. Hunter, it maybe answered, had not the prolixity of a 
French surgeon's account to make him doubtful on the subject. When 
I speak of prolixity in this case, it is not from disrespect. Though 
De la Peyrouse's surgeon was mistaken, still his descriptions are so 
minute as to enable the reader to comprehend what symptoms were 
present. It was from the description, not from the name, of the dis- 
ease, that I suspected De la Peyrouse's cases were not venereal, and 
it was natural to transfer this scepticism to the South Sea disease. 
On examination it was found, that the account, defective as it is, 
would authorize the same conclusion. 



SECTION VI. 

Of the Cause of the poisonous Quality — Fermentation — Action. 

As the consideration and explanation of this point will throw some 
light upon the disease, and cure, I may be allowed to dwell a little 
upon it. It has been supposed by some, that the poisonous quality of 
the matter arises from a fermentation taking place in it as soon as it is 
formed. But whether this poisonous quality arises from that cause; 
or whether the animal body has a power of producing matter accord- 
ing to the irritation given, whereby the living powers, whenever irri- 
tated in a particular manner, produce such an action in the parts as to 

dent to the Porpoise's voyages." — See Edin.Med. Journal, vol. II. p. 283. — The 
Porpoise is his majesty's ship, of which Mr. Wilson was surgeon, and arrived 
at Port Jackson in June, 1801. 



30 OP THE VENEREAL POISON- CHAP. I. 

generate a matter similar in quality to that which excited the action, 
is what I am now to consider. 

In the examination of this subject, I shall confine myself to the 
gonorrhoea. In support of either of the two opinions, it must be sup- 
posed that the venereal matter has, by its specific properties, a power 
of irritation beyond common matter. I have already observed, that 
it has the power of exciting inflammation even on the common skin, 
and of forming a chancre, which power is not possessed by common 
matter. In the first opinion, it must be supposed that there is no spe- 
cific inflammation or suppuration produced by the application of the 
venereal matter, but only a common inflammation and suppuration, and 
that the matter capable of producing these effects acts as a ferment up- 
on the new-formed matter, rendering it venereal as soon, or nearly as 
soon, as it is formed; and as there is a succession of secretions, there im- 
mediately follows a succession of fermentations. Now, let us see how 
far this idea agrees with all the variety of phenomena attending the 
disease. First, it may be asked, what becomes of this ferment in 
many cases where the suppuration does not come on for some weeks 
after the irritation and inflammation have taken place ? In such cases, 
we can hardly suppose the original venereal matter to remain, and to 
act as a ferment. Secondly, when there is a cessation of the dis- 
charge, and no matter formed, which sometimes happens for a consi- 
derable time, and yet all the symptoms recur, what is it that produces 
this fermentation a second time? Nothing can, but a new application 
of fresh venereal matter. When, for example, the irritation is trans- 
lated to the testicle, and the discharge is totally stopped, as often hap- 
pens, what becomes of the virus? and how is a new virus formed when 
the irritation falls upon the urethra? Thirdly, if the poisonous quality 
were produced by fermentation taking place in the matter already form- 
ed, it would not be an easy matter to account for the symptoms ever 
ceasing; for, according to my idea of a ferment, it would never cease 
to act if new matter were continually added, nor could any thing pos- 
sibly check it but a substance immediately applied to the part, which 
could stop or prevent the fermentation in the new matter. But as 
the venereal inflammation in this species of the disease is not kept up 
beyond a certain time, the production of the poison cannot depend on 
fermentation. Fourthly, if it depended on a fermentation in the secre- 
ted matter, all venereal cases would be alike, nor would one be worse 
than another, except from a greater or smaller number of fermenta- 
ting places. Upon this supposition, also, all cases would be equally 
easy of cure; for the fermentation would be equally strong in a slight 
case as in a bad one. It can only be fermentation in the matter after 
it has left the vessels. 

When the venereal matter has been applied to a sore, so as to irri- 
tate, it produces a venereal irritation and inflammation. But even 
this does not always take place; for the common matter from the sore 



SECT. VI. OP THE VENEREAL POISON. 31 

may remove the venereal matter applied, before it can affect the sore 
so as to produce the venereal inflammation and suppuration there. 
This experiment I have made several times, and have only once pro- 
duced the venereal inflammation. But if the venereal matter were 
capable of acting as a ferment, then it would in all cases produce 
venereal matter, without altering the nature of the sore. 

The effects produced by venereal poison, appear to me to arise 
from its peculiar or specific irritation, joined with the aptness of the 
living principle to be irritated by such a cause, and the parts so irri- 
tated acting accordingly. I shall, therefore, consider it as a poison, 
which, by irritating the living parts in a manner peculiar to itself, 
produces an inflammation peculiar to that irritation, from which a 
matter is produced peculiar to the inflammation. Let us consider 
how far this opinion agrees with the various phenomena attending 
the disease. 

First, the venereal matter having a greater power of irritating than 
common matter, conveys more the idea of irritation than of fermenta- 
tion. Secondly, its producing a specific disease with specific symp- 
toms and appearances, shows that it has a specific power of irritation, 
the living powers necessarily acting according to that irritation. 
Thirdly, the circumstance of the inflammation having its stated time 
of appearance and termination, is agreeable to the laws of the animal 
economy in most cases, as it is a circumstance that takes place in 
other diseases that have a crisis; and when the disease is longer of 
duration in some than in others, it is because they are much more 
susceptible of this kind of irritation, and there maybe perhaps other 
concurrent circumstances. Fourthly, the venereal inflammation 
being confined to a specific distance is more agreeable to the idea of 
a specific irritation, than that of a fermentation. Fifthly, we have a 
further proof of this opinion, from the appearance of the disease being 
translated from one part of the body to another, as in the case of the 
swelled testicle, in which the discharge is often stopped, or otherwise 
affected. Sixthly, the discharge often stops from the constitution 
being attacked by a fever, and returns after some days or weeks, or 
not at all, according to the continuance of the fever. Now we can 
plainly see, why the fever should put a stop to the discharge, as the 
disposition produced by it in a part is very different from that dispo- 
sition which formed the matter; and we can plainly see, why the 
same disposition to form matter should often return; but how that 
return should be venereal, upon the principles of fermentation, we 
do not see. Seventhly, the production by art of an irritation of ano- 
ther kind, which is not specific, removes the specific irritation; 
now an irritation of another kind cannot prevent the fermentation 
from going on, but may destroy the venereal irritation. Eighthly, 
the circumstance of particular parts of our body being much more 
readily irritated than others by the venereal poison, when in the con- 



32 OF THE VENEREAL POISON. CHAP. I. 

stitution, shows that it arises from an irritation, and that of a parti- 
cular kind. Ninthly, we know of no other animal that is suscepti- 
ble of the venereal irritation; for repeated trials have shown that it 
is impossible to give it to a dog, a bitch, or an ass.* It is much 
easier to suppose, that a dog or an ass is not susceptible of many ir- 
ritations of which the human body is susceptible, as we find to be the 
case in all other specific diseases, and most poisons, than that the 
matter of the human body is susceptible of a change, of which that 
of the dog or ass is not. 

This argument is still further supported by comparing the venereal 
poison with other morbid poisons. The animal poison productive of 
the hydrophobia, seems to be produced by a particular irritation af- 
fecting certain parts, which shows, that if the body, or any part of 
the body, is irritated, it takes a disposition to act in a peculiar man- 
ner, and that this mode of action is capable of secreting such juices 
as will throw another animal into the same action. In the hydro- 
phobia, the throat and its glands are particularly affected; and how 
the saliva should become of such a nature from the same kind of 
matter being either carried into the constitution, or perhaps only by 
the general sympathy of the constitution with a local affection, and 
more particularly with the parts about the throat, is not easily to be 
accounted for, without a supposition either that the absorbed poison 
circulating can produce a specific constitutional action capable of af- 
fecting the throat and glands there, just as the poison of the small- 
pox affects the skin, or that the circulating poison has power to affect 
or irritate the glands of the mouth only, or that those parts only are 
capable of immediately sympathizing with the part irritated, as the 
muscles of the lower jaw are when they produce the locked jaw. 

If this theory be just, it explains why epidemical diseases, arising 
from particular seasons, particular constitutions of air, &c. irritate in 
such a manner, as to produce a fever, the effluvia of which shall irri- 
tate in the same manner. For it is not in the least material how the 
original irritation arises, it is only necessary that there should exist 
in the animal a power of acting according to the stimulus given by that 
irritation. 



It is very curious, in this and the subsequent passage, to remark 
how exactly Mr. Hunter has followed the mode of reasoning propos- 
ed by Bacon instead of the syllogism, which, in physiology, is liable 

* Ihave repeatedly soaked lint in matter from a gonorrhoea, chancre, and bubo, 
and introduced it into the vagina of bitches, without producing any effect. I 
have also introduced it into the vagina of asses, without any effect. I have intro- 
duced it under the prepuce of dogs without any effect. I have also made inci* 
sions and introduced it under the skin, and it has only produced a common sore 
I have made the same experiments upon asses, with the same result. 



SECT. VI. OF THE VENEREAL POISON. 33 

to many objections. " Nothing," says the father of modern phi- 
losophy, " really exists but individual bodies having certain indivi- 
dual actions according to a law; and the business of philosophy, the 
object of every experiment, and the only rational foundation of any 
theory, is the discovery and tracing of that law." The venereal poi- 
son is only known by the action which follows its application; of this 
action, therefore, only, does Mr. Hunter speak. He traces the forms 
produced by the action, and describes them accurately. When he 
has collected a sufficient number of facts to trace the uniformity of 
each by their result, he considers such individual actions as laws; 
having established which, he is enabled to account for certain forms 
which to others appeared inexplicable, and with whom a Proteus- 
like disease was the most convenient term for indolence or incapacity. 
In this last paragraph Mr. Hunter has assumed more than is ne- 
cessary to prove his own position. Those contagions which are uni- 
versally admitted as such, viz. small-pox, scarlet fever, and measles, 
can always be traced to a cause in all respects similar to the effect. 
But camp fevers, dysenteries, and other diseases which are only found 
where men are confined together under unfavourable circums-tances, 
arise from those very circumstances, without the necessity of any 
communication with others under similar diseases. It is not less 
certain, that such epidemics as arise under certain seasons and par- 
ticular constitutions of the air, cease with those seasons and with that 
constitution, whereas the contagions rarely cease till all who are sus- 
ceptible of them have passed through them. Whenever the plague 
occurs in Egypt, it always ceases as the summer solstice arrives, and 
in England it has always ceased as the cold weather has set in. Dy- 
sentery ceases, or becomes only sporadic, as the winter or spring ar- 
rives, and influenza ceases with the change in the constitution of the 
air. Thus, if the matter excited by these diseases is contagious, the 
human constitution loses its susceptibility of such impression as the 
constitution of the air changes. This shews a marked difference 
between the two, and proves that it is very " material how the origi- 
ginal irritation arises." As this inquiry is not necessarily connected 
with the present treatise, it is probable the author was less anxious in 
the choice of his expressions. But this is not a sufficient apology; 
and it appeared necessary to caution the young reader that he is not 
implicitly to rely on names, however deservedly celebrated. 



64 OP THE VENEREAL POISON* < HAP. HI. 

CHAP. II. 

The Mode of Venereal Infection. 

Every infectious disease has its peculiar manner of being caught, 
and among mankind there is generally something peculiar in the way 
of life, or some attending circumstance, which exposes them, at one 
time or other, to contract such diseases, and which, if avoided, would 
prevent their propagation. The itch, for instance, is generally caught 
by a species of civility, the shaking of hands; therefore the hand is 
most commonly the part first affected. And as the venereal infection 
is generally caught by the connection between the sexes, the parts of 
generation commonly suffer first. From this circumstance, people 
do not suspect this disease, when the symptoms are any where else, 
while they always suspect it in every complaint of those parts. 

In the lower class of people, one as naturally thinks of the itch 
when there is an eruption between the fingers, as in young men of 
the venereal disease whose genitals are affected: but as every se- 
creting surface, whether cuticle or not cuticle, (as w r as explained be- 
fore,) is liable to be infected by the venereal poison when it is appli- 
ed to it, it is possible for many other parts besides the genitals to re- 
ceive this disease. Therefore it appears in the anus, mouth, nose, 
eyes, ears, and, as has been said, in the nipples of women who suckle 
children affected by it in their mouths; which children have been in- 
fected in the birth from the diseased parts of the mother. 



CHAP. III. 

Of the different Forms of the Disease. 

The venereal poison is capable of affecting the human body in 
two different ways; locally, that is, in those parts only to which it is 
first applied; and constitutionally, that is, in consequence of the ab- 
sorption of the venereal pus which affects parts while diffused in the 
circulation. 

Between the first and second kind, or the local and constitutional * 
certain intermediate complaints take place in the progress of absorp- 

* I have called this form of the disease, constitutional; yet it is not strictly so 
for every complai' t, in consequence of it, is truly local, and is produced bv the 
simple application of the poison to the parts. J 



SECT. I. ©F THE VENEREAL POISON. 35 

tion; these are inflammations and suppurations, forming what are 
called buboes, in which the matter is of the same nature with that 
of the original disease. 

When the matter has got into the constitution, and is circulating 
with the blood, it there irritates to action. There are produced from 
that irritation many local diseases, as blotches on the skin, ulcers in 
the tonsils, thickening of the periosteum and bones. 

The local or first kind is what I have called immediate, arising im- 
mediately upon the application of venereal pus. Of this kind there 
are two sorts, seemingly very different from one another. In the first 
there is a formation of matter, without a breach in the solids, called a 
gonorrhoea. In the second there is a breach in the solids, called a 
chancre. Neither of these two ways, in which the disease shows it- 
self, is owing to any thing peculiar in the kind of poison applied; but 
to the difference in the parts contaminated. 

The readiness with which the parts run into violent action, in this 
species of inflammation, is greater or less, according to the nature of the 
parts affected; which perhaps does not arise from any specific difference 
in the parts, but is according to the common principle of sensibility 
and Irritability; for we find, that the vagina is not so disposed to in- 
flammation in this disease as the urethra is in the same sex, because 
it is not so sensible. However, it is possible, that there may be some 
specific disposition to irritation and inflammation in the urethra in 
man; and what would incline me to think so is, that this canal is 
subject to be more frequently out of order than any other, producing 
a great variety of symptoms. 



SECTION I. 

Varieties in different Constitutions. 

This disease, when it appears in the form either of a gonorrhoea 
or a chancre, differs very much in the violence of its symptoms in 
different peoole. In some it is extremely mild, in others extremely 
violent. When mild, it is generally simple in its symptoms, having 
but few, and those of no great extent, being much confined to the spe- 
cific distance; but when violent, it becomes more complicated in its 
symptoms, having a greater variety, and extending itself beyond the 
specific distance. This does not arise from any variety in the speci- 
fic virtue of the poison, but from a difference in the disposition and 
mode of action of the body, or parts of the body: some being hardly 
susceptible of this or 3ny iiaitation, others being very susceptible of 



36 OF THE VENEREAL POISON. CHAP. HI- 

it, and of every other irritation, so as readily to run into violent ac- 
tion. 

The venereal irritation, however, does not always follow these 
rules; for I have known young men, in whom a sore from common 
accident has healed up readily, yet the irritation attending a gonorr- 
hoea has been violent, and a chancre has inflamed and spread itself 
with great rapidity, and e\en has mortified. On the other hand, I 
have known young men, in whom a sore from common violence has 
been healed with great difficulty, yet when they had contracted a go- 
norrhoea or chancre, the disease has been mild and easily curable. 

In particular people it is either mild or severe for the most part 
uniformly. In the first stated dispositions it is not invariably so; but 
then I believe there is some indisposition at the time. I have known 
several gentlemen who had their gonorrhoeas so slight in common, 
that they frequently cured themselves. But it has so happened, that 
a gonorrhoea has been remarkably severe, and has obliged them to 
apply for assistance; but then they were soon attacked with the 
symptoms of a fever, and, when the fever has gone off, the symp- 
toms of the gonorrhoea have immediately become mild. I may now 
also observe, that, when the disease is in the form of a lues venerea, 
different constitutions are differently affected. In some its progress 
is very rapid, in others it is very slow. 

Every poison, Mr. Hunter has remarked, has a specific distance; 
that is, besides the immediate breach of the. solids, it is found to pro- 
duce a certain influence to a circumscribed space. The object of 
nature seems in this case, as well as in the case of adhesions under 
inflammation from other causes, to protect the rest of the body from 
the influence of the disease; and it will be found that every morbid 
poison, in proportion as it preserves those laws by which it is cha- 
racterized, will define with greater exactness its specific distance. 
The cow-pox is the most striking illustration of this: of perhaps a 
hundred cases, the appearance will be so similar, that any one may 
serve as a description of the whole; and in all these cases, the spe- 
cific distance is beautifully marked by the regularly circumscribed 
areola which extends beyond the elevated cuticle. 

If any irregularity occurs in the progress of the disease, one of 
the first effects is an irregularity in the areola, the edges of which 
instead of being circumscribed, are jagged or diffused; that is the 
poison no longer preserves its specific distance. Smail-pox, which 
will probably hereafter be found to be only a more violent cow-pox 
is always more mild in proportion as the specific distance is pre- 
served; that is, in proportion as the surrounding inflammation ap- 
proaches, in appearance, to the areola of cow-pox. Of the distinct 
small-pox, Sydenham remarks, " the inflammation of the hands and 
face being come to its height, causes the spaces between the erup- 



CHAP. IV. OF THE VENEREAL POISON. 37 

tions to look of a pretty florid colour, not unlike a damask rose; 
and in reality the more mild and genuine the small-pox is, so much 
the more the eruptions and their intermediate spaces approach this 
colour." In the inoculated parts, (and if the eruptions are few on 
the face,) the redness is easily traced round each; but it is for the 
most part more shaded and less regular than the true cow-pox are- 
ola. To return to Sydenham, speaking of the confluent small-pox, 
he remarks, " the pustules, especially those in the face, do not rise 
so high as in the distinct kind; but, running together, appear like a 
red bladder covering the whole face." In these cases we see all 
specific distance is lost. " When mild," says Mr. Hunter, in the 
passage before us, " it is generally simple in its symptoms, having 
but few, and those of no great extent, being much confined to the 
specific distance; but when violent, it becomes more complicated in 
its symptoms, having a greater variety, and extending itself beyond 
the specific distance.''' It is not less curious to trace the uniformity 
of nature under analogous disease, than the accuracy of philosophi- 
cal observers, and their mutual agreement under different modes of 
expressing themselves. This specific distance will occur again when 
we arrive at chancres. 



CHAP. IV. 

Of the Lues Venerea being the Cause of other Diseases. 

Every animal may be said to have natural tendencies to morbid 
actions, which may be considered as predisposing causes, and these 
may be called into action whenever the immediate cause takes 
place, which may be such as to have no connection with these ten- 
dencies, and cannot, therefore, be considered as the cause of the dis- 
ease. One disease excites another, and therefore is supposed to be 
the sole cause of it. Thus slight fevers, or colds, small-pox, and 
measles, become frequently the cause of scrofula; and certain de- 
rangements of the natural actions of the body often bring on the 
gout, agues, and other diseases; but these diseases will be always 
more or less, according to the constitution and parts; and the con- 
stitutions will differ according to circumstances, which may be nu- 
merous: two of these, however, will be local situation and age. 

In this country the tendency to scrofula arises from the climate, 
which is in many a predisposing cause, and only requires some de- 
rangement, to become an immediate cause, and produce the whole 
disease. 

The venereal disease also becomes often the immediate cause of 



38 OP THE VENEREAL POISON- CHAP. IV. 

other disorders, by calling forth latent tendencies to action. This 
does not happen from its being venereal, but from its having destroy- 
ed the natural actions, so that the moment the venereal action and 
disposition is terminated, the other takes place; and 1 have seen in 
many cases the tendency so very strong, that it has taken place be- 
fore "the venereal has been entirely subdued; for by pursuing the 
mercurial course, the symptoms have grown worse; but by taking up 
the new disposition, and rendering it less active than the venereal, 
the venereal has come into action anew; and these eifects have taken 
place alternately several times. In such cases, it is a lucky circum- 
stance when the two modes of treatment can be united; but where 
they act in opposition, it is very unfortunate. If the venereal dis- 
ease attacks the lungs, although that disposition may be corrected, 
consumption may ensue; and in like manner, where the bones are af- 
fected, or the nose, scrofulous swellings, or fistula lacrymalis, may 
be the consequence, though the disease may have been cured. 

Many of the diseases arising from this source appear to be pecu- 
liar to such causes, ajld seem to be formed out of the constitution, 
the disease, and method of cure. It is therefore difficult to say of 
what nature such a disease may be; but it will in general have a 
particular tendency from the constitution; and if w r e are acquainted 
with the general tendency of a constitution, we are to suspect that as 
the strongest cause, and that the disease will partake more of it than 
the other. In this country these complaints have most commonly a 
scrofulous tendency, and are often truly scrofulous, the disease par- 
taking more of that disposition than any other. 

Parts have also their peculiar tendency to diseases, which are 
stronger than those of the constitution at large; and when injured 
they will of course fall into the morbid action, arising from such 
tendencies. Therefore, when parts have had their natural actions 
destroyed by a venereal irritation, those tendencies will be brought 
into action; and therefore, the diseases arising from the tendencies 
of such parts are to be kept in view. They will be assisted like- 
wise by local situation and age. 

In particular countries, and in young people, the tendency to scro- 
fula will be predominant; therefore buboes in them will more rea- 
dily become scrofulous. In old people they may form cancers; and 
when in parts of the body which have a particular tendency to' can- 
cer, that disease will more readily take place. 

The want of knowledge, and of attention to this subject, has been 
the cause of many mistakes; for whenever such effects have been 
produced, in consequence of the venereal disease, it has immediately 
been blamed, and not only as a cause, but it has been supposed to be 
the disease itself. This is an inference natural enough to those who 
cannot see that a variety of causes are capable of producing one ef- 
fect; or, in other words, that where the predisposing caus & e is the 
same, a variety of immediate causes may produce the same action. 



CHAP. IV. OF THE VENEREAL POISON. 39 

It shows great ignorance, however, to suppose the venereal disease 
can be both the predisposing and immediate cause. 

When the venereal disease attacks the urethra, it often becomes 
itself the predisposing cause of abscesses, and many other complaints; 
When it attacks the outside of the penis, forming chancres, they 
often ulcerate so deep as to communicate with the urethra, producing 
fistula in the urethra, and often a continued phymosis. 

In describing diseases which, like the venereal disease, admit of a 
great variety of symptoms, we should keep a middle line, first giving 
the most common symptoms of the disease in each form; then the 
varieties which most commonly occur; and last of all the most un- 
common: but it will not be easy to take notice of every possible va- 
riety. Therefore, when a variety occurs not mentioned, it is not to 
be supposed, that the author is leading his readers astray, or is unac- 
quainted with the disease at large. If his general principles are 
just, they will help to explain most of the singularities of .the 
disease. 



There is a most unfortunate obscurity in this chapter, for w r ant of 
a definition of scrofula and of cancer. The whole amounts to this, 
that in some people sores heal readily; or, as they generally express 
themselves, they have good flesh to heal; in others the reverse takes 
place. If in the latter a venereal sore should have existed long, its 
surface maybe so considerable, that, after its venereal disposition is 
subdued, a very troublesome ulcer may remain, which, if it becomes 
indolent, may come under the too frequent and vague term of scro- 
fula. If the disease happens to be in the inguinal-glands, the num- 
ber of parts differently affected from the deep seat of the suppurated 
gland may produce different actions on different surfaces of the same 
sore, as will be remarked hereafter; and if the constitution and parts 
have been perpetually harassed with mercury, the ulcer may become 
go painful, and for some time so untractable, as to assume all these 
characters of cancer. But as both scrofula and cancer are terms no 
where defined in Mr. Hunter's publications, I wish he had never used 
them. 



40 OF GONORRHOEA*. CHAP. I. 



PART II. 



CHAP. I. 

Of Gonorrhoea. 

When an irritating matter of any kind is applied to a secreting 
surface, it increases that secretion, and changes it from its natural 
state (whatever that be) to some other. This, in the present dis- 
ease, is pus. 

When this takes place in the urethra, it is called a gonorrhoea; 
and as it arises from the matter being applied to a non-cuticular sur- 
face, which naturally secretes some fluid, it is of no consequence in 
what part of the body this surface is; for, if in the anus, it will pro- 
duce a similar discharge there, and a similar effect on the inside of 
the mouth, nose, eyes, and ears. It is conceived by some that gonor- 
rhoeas may take place without the above-mentioned immediate cause; 
that is, that they may arise from the constitution; if so, they must 
be similar to what is supposed to be a venereal ophthalmia. But from 
the analogy of other venereal affections, proceeding from the consti- 
tution, I very much suspect the existence of either the one or the 
other; for when the poison is thrown upon the mouth, throat, or nose, 
it produces ulcers, and not an increased secretion, like a gonorrhoea. 
But we never find an ulcer on the inside of the eye-lids in those oph- 
thalmias; and gonorrhoeas in the urethra are too frequent to proceed 
from such a cause. 

Till about the year 1753, it was generally supposed, that the mat- 
ter from the urethra, in a gonorrhoea, arose from an ulcer or ulcers 
in that passage; but from observation it was then proved that this 
was not the case. 

It may not be improper to give here a short history of the disco- 
very, that matter may be formed by inflammation, without ulceration. 
In the winter 1749, a child was brought into the room, used for dis- 
section, in Covent Garden; on opening of whose thorax a laro-e 
quantity of pus was found loose in the cavity, with the surface of the 
lungs and the plura furred over with a more solid substance similar 
to coagulable lymph. On removing this from those surfaces, they 
were found entire. This appearance being new to Dr. Hun er he 
sent to Mr. Samuel Sharp, desiring his attendance; and to him it 



CHAP. I. OF GONORRH(EA. 41 

also appeared new. Mr. Sharp, afterwards, in the year 1750, pub- 
lished his " Critical Inquiry," in which he introduced this fact, 
" That matter may be formed without a breach of substance;" not 
mentioning whence he had derived this notion. It was ever after 
taught by Dr. Hunter in his lectures. We, however, find writers 
adopting it, without quoting either Mr. Sharp or Dr. Hunter. So 
much being known, I was anxious to examine, whether the matter in 
a gonorrhoea was formed in the same way. In the spring of 1753, 
there was an execution of eight men, two of whom I knew had at 
that time very severe gonorrhoeas. Their bodies being procured for 
this particular purpose, we were very accurate in our examination; 
but found no ulceration. The two urethras appeared merely a little 
blood-shot, especially near the glans. This being another new fact 
ascertained, it could not escape Mr. Gataker, ever attentive to his 
emolument, who was then attending Dr. Hunter's lectures, and also 
practising dissection under me. He published, soon after, in 1754, a 
treatise on this disease, and explained fully, that the matter in a go- 
norrhoea did not arise from an ulcer, without mentioning how he ac- 
quired this knowledge; and from that time successive writers have 
repeated the same doctrine. Since the period mentioned above, I 
have constantly paid particular attention to this circumstance, and 
have opened the urethra of many who, at the time of their death, 
had a gonorrhoea, yet have never found a sore in any; but always ob- 
served that the urethra, near the glans, was more blood-shot than 
usual, and that the lacuna? were often filled with matter. I have in- 
deed seen an instance of a sore a little within the urethra; but this 
sore was not produced by any ulceration of the surface, but from an 
inflammation taking place, probably, in one of the glans, which pro- 
duced an abscess in the part, and that abscess opened its way into 
the urethra. The very same sore opened a way through externally at 
the fraenum, so that there was a new passage for the urine. Indeed 
the method of curing a gonorrhoea might have shewn that it could 
not depend upon a venereal ulcer; for there is hardly an instance of 
a venereal ulcer being cured by any thing but mercury, escharotics 
excepted. We know, however, that most gonorrhoeas are curable 
without mercury; and, what is "still more, without any medical as- 
sistance; which, I believe, is never the case with a chancre. Tins 
doctrine, that a gonorrhoea does not depend on ulcers, was first taught 
publicly by Dr. Hunter, at his lectures, in the year 1750; but he did 
not attempt to account for it. 

To understand this exordium, the reader must observe, that Mr. 
Hunter is speaking of two modes in which a part may be affected by 
the venereal disease:— the first is, by the immediate application of 
the poison taken from a chancre or gonorrhoea; the second, by the 
poison absorbed from that chancre, and producing its effects in riiHer- 

F 



42 ©P GONORRHEA. CHAP. i. 

ent parts of the constitution. The first, he conceives, will produce 
an increased and altered discharge on any secreting surface to which 
it is applied. The second, on the contrary, always produces ulcera- 
tion. Hence a gonorrhoea, he conceives, can never be the effect of 
the poison absorbed, or, as it is often called, of the constitutional dis- 
ease, unless the purulent eye is admitted to arise from the constitu- 
tional disease. Neither one nor the other seem probable, because 
the effect of the poison absorbed in other secreting surfaces is always 
ulceration, as we see in the mouth, throat, or nose. 

In the progress of the work it will be seen, that Mr. Hunter proves 
the matter from the chancre to be different from the matter of the 
ulcers, produced by absorption, which may account for the different 
effect of each on secreting surfaces. Mr. Ware, who imputes the 
purulent eye, in some instances, to the irritation of venereal matter, 
conceives the matter to be always derived from the primary disease, 
and not from secondary or constitutional ulcers. 

If this passage and' the commentary should be found obscure, the 
reader may pass them over till the subject is renewed, when the se- 
condary symptoms are considered. In the passage before us the 
theory is, perhaps, too much anticipated for those who have no pre- 
vious knowledge of it. 

The remainder of this section shows, by an illustration which may 
be called truly practical, the absurdity of making a distinction be- 
tween pus and mucus, when all the apparent and physical properties 
are the same. Mucous membranes, in a healthy state, certainly 
secrete a substance different from the pus of an healthy ulcer; but 
under disease they secrete a similar substance: that such is the case, 
as far as the senses are concerned, is evident, from the language used 
by medical men. When gonorrhoea was supposed to arise from ulcer, 
the discharge was always called pus; when it was found to exist 
without ulcer, the name of the discharge was altered, not from any 
change discovered in its properties, but in order to adopt the lan- 
guage to a theory which required a breach of the solids in order to 
produce pus. 



SECTION I. 

Of the Time between the Application of the Poison and Effect. 

In most diseases there is a certain time between the application ol 
the cause, and the appearance of the effect. In the venereal disease 
this time is found to vary considerably, owing probably to the state of 
the constitution when the infection was received. Each form of the 
disease also varies in this respect; the gonorrhoea and chancre bein* 



SECT. I. OF GONORRHOEA. 43 

earlier in their appearance after contamination than the lues venerea, 
and of the two former, the gonorrhoea appearing sooner than the 
chancre. In the gonorrhoea, the times of appearance are very differ- 
ent. I have had reason to believe, that in some the poison has taken 
effect in a few hours, while in others it has been six weeks; and I 
have had examples of it in all the intermediate periods. So far, 
however, as we can rely upon the veracity of our patients, (and fur- 
ther evidence we cannot have,) six, eight, ten, or twelve days should 
appear to be the most common period, though it is capable of affect- 
ing some people much sooner, and others much later. I was in- 
formed by a married gentleman who came from the country, and left 
his wife behind him, that in a frolic he went to a bagnio, and had 
connexion with a woman of the town. The next morning he left 
her, and he had no sooner got to his lodging, than he felt a moisture 
of the part, and upon inspection he found a beginning gonorrhoea, , 
which proved a very troublesome one. I was told by another gen- 
tleman, that he had been with a woman over night, and in the morn- 
ing the gonorrhoea appeared; and that the same happened to him 
twice. I was informed by a third gentleman, that the discharge ap- 
peared in six-and-thirty hours after the application of the poison. In 
the above-mentioned patients, the infection must have arisen from 
the poison applied at those stated times, as neither of these patients 
are supposed to have had an opportunity of receiving the infection for 
many weeks before. 

These assertions, from men of veracity, and where there could be 
no temptation to deceive, not even an imaginary one, are sufficient 
evidences. On the other hand, upon equally good authority, I have 
been informed, that six weeks had passed, after the application, be- 
fore any symptom appeared. The patient had strange and uncom- 
mon complaints preceding the running, such as an unusual sensation 
in the parts, with most of the other symptoms of gonorrhoea, except 
the discharge. He had the same complaint about twelve months 
afterwards; and then it was four weeks from the application of the 
poison before it appeared, giving, for some part of that time, the 
former disagreeable sensations; but from his late experience he sus- 
pected what was coming. Fiom this I am inclined to believe, that 
it seldom or never lies perfectly quiet so long, and that the inflam- 
matory state may take place for some considerable time before the 
suppurative ; and in these cases there is less disposition for a cure, 
as the very disposition which forms a running is, in general, a salu- 
tary one, and is an intermediate step between the disease, which is 
the inflammation, and the cure; for in the time of suppuration a 
change has taken place in the vessels, producing the formation of 
matter. If this change should never take place, it is not certain what 
would be the consequence; whether the inflammation would go off 
without suppuration, as in many common inflammations, I have not 
been able to determine, but should suspect that it would continue 



44 OF GONORRHOEA. CHAP. I 

much longer than usual, because the parts have not completed their 
actions; and I also suspect that such cases always arise from some 
peculiarity of constitution. 

This uncertainty in the appearance of the disease, after the appli- 
cation of the poison, exists in alf the other morbid poisons, though all 
of them, like the venereal, has a medium, which generally prevails. 
Inoculation of small-pox, or vaccination, give us the fairest opportu- 
nities of observing these varieties. They may sometimes be traced 
to other indispositions, interfering with the action which the poison 
applied would otherwise induce; in other instances they are not to be 
accounted for, but by admitting a peculiarity of constitution. 



SECTION II. 

Of the Difficulty of distinguishing the Virulent from the Simple 
Gonorrhoea. 

The surface of the urethra is subject to inflammation and suppu- 
ration from various other causes besides the venereal poison; and 
sometimes the discharges happen spontaneously when no immediate 
cause can be assigned. Such may be called simple gonorrhoeas, 
having nothing of the venereal infection in them ; though those per- 
sons that have been formerly subject to virulent gonorrhoeas are most 
liable to them. It is given as a distinguishing mark between the 
simple and the virulent gonorrhoea, that the simple comes on imme- 
diately after copulation, and is at once violent; whereas the virulent 
comes on some days after, and gradually. But the simple is not in 
all cases a consequence of a man's having had connexion with wo- 
men, it does not always come on at once, nor is it always free from 
pain. On the other hand, we see many venereal gonorrhoeas that 
begin without any appearance of inflammation; and I have been very 
much at a loss to determine whether they were venereal or not; for 
thereiare a certain class of symptoms common to almost all diseases 
of the urethra, from which it is difficult to distinguish the few that 
arise solely from the specific affection. I have known the urethra 
sympathize with the cutting of a tooth,* producing all the symptoms of 
a gonorrhoea. This happened several times to the same patient. 
The urethra is known to be sometimes the seat of the gout.f I have 

* Nat. Hist, of Teeth.pt. II. p. 12". 

t Essays and Obs. Phys. and Liter, of Edin. v. HI. p. 425. 



SECT. IF. OF GONORRHOEA. 45 

known it the seat of the rheumatism. The urethra of those who have 
had venereal complaints, is more apt to exhibit symptoms similar to 
gonorrhoea, than the urethra of those who have never had any such 
complaint; and it is generally in consequence of the parts having 
been hurt by that disease, that the simple gonorrhoea comes on; 
which, perhaps, is also a reason why they are in some measure simi- 
lar. A discharge, and even pain attacks the urethra ; and strange 
sensations are every now and then felt in these parts, which may be 
either a return of the symptoms of the venereal disease without virus; 
may arise as it were spontaneously; or may be a consequence of some 
other disease. When it happens in consequence of some venereal 
gonorrhoea, it is seldom constant, and may be called a temporary 
gleet, ceasing for a time and then returning ; but in such cases the 
parts seldom swell ; the glans does not change to the ripe cherry- 
colour, nor does it sweat a kind of matter. Such a complaint, as a 
discharge without virus, is known to exist by its coming on when 
there has been no late connexion with women, and likewise by its 
coming on of its own accord where there had never been any former 
venereal complaint, nor any chance of infection. From its commonly 
going off soon, both in those who have had connexion with women, 
and in those who have not, it becomes very difficult in many cases to 
determine whether or not it is venereal; for it is often thought vene- 
real when it really is not so; and, on the other hand, it may be sup- 
posed to be only a return of the gleet, when it is truly venereal; but 
perhaps this is not so material a circumstance as might at first be 
supposed. These diseases, when they are a consequence of former 
venereal complaints, may be considered only as an inconvenience 
intailed on those who have had the venereal gonorrhoea. No certain 
cure for them is known; they are similar to the fluor albus in women. 



There is not in the whole treatise, a section more necessary to be 
kept in view than the above. We every day meet with fluor albus 
in women without suspecting a venereal origin, yet we often reason 
as if every gonorrhoea in men must be venereal. Hence we are told 
of the frequency with which gonorrhoea, when communicated, pre- 
serves its own form without producing chancre; and it has even 
been said that the matter of gonorrhoea has been inoculated without 
producing chancre. All this is highly probable, because we have 
no means of ascertaining whether these gonorrhoeas were venereal; 
and it is most probable, considering the frequency of that disease be- 
fore the venereal was known, that the greater number of gonorrhoeas 
are not venereal: but, that some are venereal, and differ only from 
chancre by the part on which the poison has produced its irritation, 
has been, I trust, satisfactorily proved, 



46 OP GONORRHOEA. CHAP. I. 



SECTION III. 

Of the common final intention of Suppuration not answering in the 
present Disease. 

When a secreting surface has once received the inflammatory ac- 
tion, its secretions are increased, and visibly altered. Also when the 
irritation has produced inflammation and an ulcer in the solid parts, 
a secretion of matter takes place, the intention of which in both 
seems to be to wash away the irritating matter; so that it is the end 
of irritations to produce their own destruction, like a mote in the eye, 
which, by increasing the secretion of tears, is itself washed away. 
But in inflammations arising from specific or morbid poisons, this ef- 
fect cannot be produced; for although the first irritating matter be 
washed away, yet the new matter formed has the same quality with 
the original; and therefore, upon the same principle, it would pro- 
duce a perpetual succession of irritations, and of course secretions, 
even if there were no other cause for the continuance than its own 
matter. But the venereal inflammation is not kept up by the pus 
which is formed; but, like many other specific diseases, by the spe- 
cific quality of the inflammation itself. This inflammation, how- 
ever, it would appear, can only last a limited time; the symptoms pe- 
culiar to it vanishing of themselves by the parts becoming less and 
less susceptible of irritation. This circumstance is not peculiar to 
this particular form of the venereal disease; it is perhaps common 
to almost every disease that can affect the human body. ' From hence 
it will appear, that the consequent venereal matter has no power of 
continuing the original irritation; and indeed, if this were not the 
case, there would be no end to the disease. 

As the living principle in many diseases is not capable of conti- 
nuing the same action, it also loses this power in the present, when 
the disease is in the form of a gonorrhoea, and the effect is at last 
stopped, the irritation ceasing gradually. This cessation will vary 
according to circumstances; for if the irritated parts are in a state 
very susceptible of such irritations, in all probability their actions 
will be more violent and continue longer; but in all cases the differ- 
ence must arise from the difference in the constitution, and not from 
any difference in the poison itself. 

The circumstance of the disease ceasing spontaneously, only hap- 
pens when it attacks a secreting surface, and when a secretion of 
pus is produced; for when it attacks a non-secreting surface, and pro- 
duces its effects there, that is an ulcer; the parts so affected are capa- 
ble of, continuing the disease, or this mode of action, for ever as will 
be taken notice of when we shall hereafter consider chancre. But 
this difference between spontaneous and non-spontaneous cure seems 



SECT. III. OP GONORRHOEA. 47 

to depend more on the difference in the two modes of action than on 
the difference in the two 'surfaces; for when the disease produces an 
ulcer on a secreting surface, which it often does from the constitution 
as on the tonsils, it has no disposition to cure of itself; nor in the 
urethra, in a recent case, if ulcers are formed there, would they heal 
more readily than when formed in any other part. 

The common practice proves these facts. We every day see go- 
norrhoeas cured by the most ignorant; but in chancre, or the lues ve- 
nerea, more skill is necessary. The reason is obvious: gonorrhoea 
cures itself, whilst the other forms of the disease require the assist- 
ance of art. 

It sometimes happens, that the parts, which become irritated first, 
get well, while another part of the same surface receives the irrita- 
tion, which continues the disease, as happens when it shifts from the 
glans to the urethra. 

From this circumstance of all gonorrhoeas ceasing without medi- 
cal help, I should doubt very much the possibility of a person getting 
a fresh gonorrhoea while he has that disease; or of his increasing the 
same by the application of fresh matter of its own kind. And this 
observation holds in all the forms of the disease; for it has been 
proved, that the application of the matter from a gonorrhoea to a 
bubo does not in the least retard the cure of that bubo; nor does the 
matter of a chancre applied to a bubo, nor the matter of a bubo ap- 
plied to a chancre, produce any bad effect; though, if venereal mat- 
ter is applied to a common sore, it will often produce the venereal 
irritation. By all which I am led to believe, that the venereal mat- 
ter formed in a gonorrhoea does not assist in keeping up that gonor- 
rhoea; for it is only an application of matter, the poison and effects 
of which are exactly similar to the effects upon the solids already 
produced; and that nothing could increase or continue the effect but 
something that is capable of increasing the disposition of the parts 
themselves to such inflammation, or of making them more suscepti- 
ble of it. We find, besides, that a gonorrhoea may be cured while 
there is a chancre, and vice versa: now if fresh venereal matter were 
capable of keeping up the disease, no gonorrhoea could ever get well, 
while there is this supply of venereal matter.* From all this it is 

* When treating of pus, in my lectures, I obsevved that I was inclined to be- 
lieve, that no matter, of whatever kind, can produce any effect upon the part 
that formed it ; nor do I believe, that the matter of any sore, let it be what 
it will, ever does or can do any hurt to that sore; tor the parts which formed the 
matter are of the same nature, and cannot be irritated by that which they pro- 
duced, except extraneous matter is joined with it. The gland which forms the 
poison of the viper, and the duct which conveys it to the tooth, are not irritated 
by the poison: and it would appear, from Abbe Fontana's experiments, that the 
viper cannot be affected by its own poison. Vide Trait e sur le Venin de la Vi- 
pere. par M. F. Fontana, vol. I. page 22. If what I have now advanced is true, 
taking, or washing away matter under the idea of keeping the parts clean, is in 
iv case absurd. 



48 OF GONORRHOEA. CHAP. t. 

reasonable to suppose, that such a surface of an animal body is not 
capable of being irritated beyond a certain time; and therefore, if 
fresh venereal matter were continued to be applied to the urethra of 
a man having a gonorrhoea, that it would go off as soon as if no such 
application had been made, and get as soon well as if great pains had 
been taken to wash its own matter away. The same reasoning holds 
good in chancres. 

I carry this idea still further, and assert, that the parts become less 
susceptible of the venereal irritation; and that not only a gonorrhoea 
cannot be continued by the application of either its own or fresh mat- 
ter; but that a man cannot get a fresh gonorrhoea, or a chancre, if 
he applies fresh venereal matter to the parts when the cure is nearly 
completed, and continues the application ever after, or at least at 
such intervals as are within the effect of habit. I can conceive, that 
in time the parts may become so habituated to this application as to 
be insensible of it; for by a constant application, the parts would ne- 
ver be allowed to forget this irritation, or rather never become unac- 
customed to it; and therefore this supply of fresh matter could not 
affect the cure so as to renew the disease, till they first recovered their 
original and natural state; and then they would be capable of being 
affected again. 

This opinion is not derived from theory only, but is founded on 
experience and observation. A man, immediately after having suf- 
fered a gonorrhoea, shall have frequent connections with women of the 
town, and that for years successively, without being infected; yet a 
fresh man shall contract it immediately, from the very same woman; 
and if the first-mentioned man were to be out of the habit of this 
irritation for some time, he would then be as easily infected as the 
other. Where this habit is not so strong as to prevent altogether the 
parts from being affected, still it will do it in part; and it is a strong 
proof of this, that most people have their first gonorrhoea the most 
severe, and the succeeding ones generally become milder and milder, 
till the danger of infection almost vanishes. 

This seems to be explained by the following facts. A married man, 
who had had a communication with his wife only for several years, 
slept with a woman with whom he had formerly cohabited. She 
gave him a severe gonorrhoea, and declared that she was not con- 
scious of being diseased. He put himself and her under my care; 
and while they were going on with their cures they still continued 
their intercourse, which I readily allowed. He got well, and it was 
supposed she got well also. The intercourse was continued between 
them for many months after, without any mischief received on his 
side, or any suspicion of remaining disease on hers. At last this 
connection was broken off; and she formed another attachment: she 
no sooner formed this new attachment than she gave her new lover a 
gonorrhoea; she now flew to me for a cure, and declared that she had 
no connection but with the two gentlemen beforp mentioned, and 



SECT. III. OF GONORRH(EA. 49 

therefore that the present disease must be the same for which I had 
attended her formerly. Her second lover was not a patient of mine; 
but I gave her medicines which she very much neglected to take. 
Her lover continued his connection, as the first had done, for several 
months after he had got well, without any further infection from her; 
but unfortunately her first lover returned about a twelvemonth after; 
and, thinking himself secure, as she lived in peace with the present, 
renewed his acquaintance with her, and but once. The consequence, 
however, was a gonorrhoea. 

Had the woman the gonorrhoea all this time? And what was the 

>n why those gentlemen did not catch the disease, except after 

that .he acquaintance had been interrupted for some time? Was it 

the effect of habit, by which the parts lost their susceptibility of that 

ion? 

The case of a young woman from the Magdalen hospital is a 
striking proof of this, as far as circumstances can prove a fact. She 
uv i received into that house, and continued the usual time, which is 
two years. The moment she came out, she was picked up by one 
who was waiting for her with a post-chaise to carry her off imme- 
■ y. She gave him a gonorrhoea. 

This opinion of parts being so habituated to this irritation as hardly 
to be affected by it, is strengthened by observing, that in the gonor- 
rhoea the violent symptoms shall often cease, and the disease shall 
still continue, spinning itself out to an amazing length, with no other 
symptoms than a discharge; yet that discharge shall be venereal. 
This I have frequently seen; and the following is an abstract of a 
singular case of this kind. 

A gentleman had connection with a woman of the town, and re- 
ceived a venereal gonorrhoea in the beginning of April, 1780. He, 
at first, could hardly believe it to be venereal, as he had kept the 
woman in the country, where she had scarcely ever been out of his 
sight; hut the violent pain in making water, great running, chordee, 
and swelled testicle, convinced him that it was venereal. When the 
cure was going on tolerably well, and he had got the better of one 
swelled testicle, the other began to swell; however, all the symptoms 
gradually disappeared, except the chordee, hardness of the epididy- 
mis, and a small gleet which was slimy. On the 12th of June he 
went into the country; while he was in the country the chordee went 
off, and the hardness of the epididymis entirely disappeared; but 
still a slimy gleet remained, although but trifling. 

September the first, he married a young lady, and endeavouring 
to enter the vagina, he found great difficulty, which brought on a 
return of the chordee, and an increased discharge. On the tenth, 
she began to complain of heat and pain, and of a difficulty and fre- 
quency in making water; and when she made water there was 
forced out some matter; she had also a dull heavy pain, and a sense 
of weight at the bottom of her belly, and round her hips, with great 

G 



SO OF GONORRHOEA. CHAP. I* 

soreness of the parts when she sat. These symptoms had been pre- 
ceded by an itching about the orifice of" the vagina. 

By taking a mercurial pill, and rubbing the parts with mercurial 
ointment, in about eight days the violence of the symptoms abated, 
they were now allowed to' cohabit; but whenever they came toge- 
ther, the pain which she suffered was excessive. The parts were 
washed with a solution of corrosive sublimate and sugar of lead, and 
anointed with mercurial ointment; which applications being conti- 
nued for some time, the soreness went off. He was treated medi- 
cally; and afterwards all was well. 

Here was a venereal gonorrhoea contracted about the beginning 
of April; all the symptoms had disappeared by the first of June, and 
there only remained some of the consequences, such as chordee, hard- 
ness of the epididymis, and a discharge of a little slimy mucus, which 
could only be observed in the morning. In a short time the chordee and 
hardness in the epididymis had entirely gone off, and merely the small 
discharge of mucus, which appeared only in the morning, remain- 
ed; yet three months after he communicated the disease to his wife. 

I was consulted in the following case by a surgeon who attended: 
July 13th, 1783, a person had connection with a woman of the town: 
the 30th, that is, seventeen days after, a gonorrhoea came on, which 
was violent. He took mercurial pills and gentle purges. In twelve 
days the violent symptoms abated, and about the 4th of September 
the discharge was stopped. On the 9th it began to appear again, 
but only lasted a few days; and would come and go in this way 
sometimes every two days, often six or seven days. On the 28th of 
September he had connection with his wife, while he had a small 
discharge. The 9th of October he had connection again; and three 
days after she complained of heat in making water, with a discharge 
and other symptoms of gonorrhoea which were violent. About the 
latter end of October her complaints were almost removed; some 
only of the symptoms appearing and disappearing till January, 1784, 
when he had connection with her to try whether she could give it 
him, viz. three months after the second connection; and in fourteen 
days after this he had all the symptoms of a gonorrhoea. April 29. 
he was not perfectly well, having a discharge, with a pain in the pe- 
rineum; and she also had a discharge. If this last attack, in Ja- 
nuary, 1784, in him was a gonorrhoea, then of course she must have 
had it; and also of course he must have lost his in the intermediate 
time, between the 9th of October, 1783, and January, 1784; for if 
he had had it also then, it could not have produced any effect upon 
him. 

It was impossible to say whether they had now the infection or 
not, for any trials upon themselves would prove but little, except one 
of them only had it so as to infect the other; but if both had it, no al- 
teration could take place in either; as it could not be ascertained 
whether they had the disease or not; and as there were suspicious 



SECT. III. OF GONORRIKEA. 5i 

symptoms in both, when joined with all the circumstances, I agreed 
with the attending surgeon, that it was most prudent to treat them 
as if actually affected with a gonorrhoea. 

If it is true, as is asserted in the voyage round the world, that the 
venereal disease was carried to Otaheite, it shows that it can be long 
retained after all ideas of existence have ceased; and when it is re- 
tained for such a length of time, it is most probably in the form of a 
gonorrhoea.* 

In like manner, a venereal bubo, if it could be kept a considera- 
ble time between the point of suppuration and resolution, would be- 
come indolent from habit, continue in that point of suspension, and 
remain perhaps almost incurable. Such, I think, I have seen, 

In considering common inflammation from whatever cause we 
have seen, that all the various processes are such as are directed to- 
wards the preservation and restoration of the part or whole con- 
stitution. If inflammation occurs on a secreting surface, forming 
a canal, its secretion is increased, and by degrees altered to a bland 
substance called pus, after which it gradually subsides. If the in- 
flammation is in a solid part, or in viscera lined with membranes, 
adhesion takes place to prevent the spreading of the disease; and if 
the cause ceases, and the first inflammation was not particularly vio- 
lent, the disease does not spread, but gradually subsides. But if the 
same cause which first induced the inflammation continues, or if the 
first inflammation produced so great a change in the parts that they 
cannot return to their original mode of action, suppuration must fol- 
low, which goes through the stages before described; after which 
the mucous membrane returns to its natural secretion, and the injur- 
ed part of the solids being removed by ulceration, is restored by granu- 
lation and cicatrization. But if either of these parts is inflamed by the 
irritation from a morbid poison, that irritation must continue so long 
as the parts are susceptible of the impression from that cause. Of the 
small-pox the constitution is not susceptible after having gone through 
a certain process. The pustules, therefore, readily heal whilst the 
matter which excited the disease remains upon them. But of the 
venereal disease the constitution is always susceptible, and the ac- 
tion excited by it continues till altered by another and more violent 
irritation. 

Hence the process of inflammation and suppuration, which is suf- 
ficient to relieve other irritations, is not sufficient to relieve a part 
from the irritation of the venereal poison, but the action which it 
has excited continues. 

Mr. Hunter has, I think, very fairly assumed that the irritation is 
not kept up by the matter secreted. However that may be, it is suffi- 
cient at present to state, what is pretty universally admitted, that the 

* Vide pape 23. 



52 OF GONORRHOEA. CHAP. I. 

constitution has no power in itself of altering the venereal action 
when once it is set up. Hence a venereal ulcer or gonorrhoea should 
continue till a new irritation is excited, so violent as to supersede it. 
In gonorrhoea, he seems to think, the irritation may cease spontane- 
ously. But this does not appear to me proved. Gonorrhoea, aris- 
ing from other causes, and those causes are very numerous, may 
cease like other inflammations on mucous membranes. But in ve- 
nereal gonorrhoea, though the parts may be so accustomed to the ir- 
ritation that the pain may cease, yet it is by no means ascertained 
that the discharge, however small in quantity, or altered in appear- 
ance, may not retain its virulent properties, that is, that the disease 
has spontaneously ceased. Even the cases mentioned by Mr. Hun- 
ter in this section, without regarding Otaheite, prove the uncertain- 
ty of the cessation of the disease. 

These cases all show the great length of time that gonorrhoea may 
continue almost unobserved, yet retain its virulence. They there- 
fore render the question at least uncertain, whether the true venereal 
gonorrhoea ever wears itself out. At the same time it may be enough 
to remark that so many means of cure may occur, without being ob- 
served, that the question must come before us again when we arrive 
at the " cure of gonorrhoea." 



SECTION IV. 

Of the Venereal Gonorrhoea. 

In treating of the seat, extent, and symptoms of gonorrhoea, I 
shall begin with such particulars as are constant or most frequent, 
and take them as much as possible in the order they become less so 
for there is a considerable variety in different gonorrhoea. 



SECTION V. 

Of the Seat of the Disease in both Sexes. 

The seat of this disease, in both sexes, is commonly the parts of 
generation. In men it is generally the urethra; though it sometimes 
takes place on the inside of the prepuce and surface of the glans. In 
women it is the vagina, urethra, labia, clitoris, or nympha^ 



SECT. V. OF GONORRHOEA. 53 

The disease has its seat in these parts from the manner in which 
it is caught. But if we were to consider the surface of contact sim- 
ply in men, we should naturally suppose that the glans-penis, or the 
orifice of the urethra, would be the first, or indeed the only parts af- 
fected; yet most commonly they are not; for though there are cases 
where the glans is affected, and where the disease goes no further, I 
believe it seldom attacks the orifice of the urethra, without passing 
some way along that canal. How far it can ever be said to aflect the 
prepuce only, I am not quite certain., although I believe it sometimes 
happens; for I have seen inflammation there, as well with, as with- 
out, a discharge from the urethra, which appeared to me to be vene- 
real. I have seen, in such cases, the inflammation extending into the 
loose cellular membrane of the prepuce, and producing a phymosis; 
and this inflammation I suspect to be of the erysipelatous kind. 

When the disease attacks the glans, and other external parts, as, 
for instance, the prepuce, it is principally about the root of that 
body, and the beginning of the prepuce, the parts where the cuticle 
is thinnest, and of course where the poison most readily affects the 
cutis; but sometimes it extends over all the glans and also the whole 
external surface of the prepuce. It produces there a soreness or ten- 
derness, with a secretion of thinnish matter, commonly without either 
excoriation or ulceration. I am not certain, however, that it does not 
sometimes excoriate those parts; for I once saw a case, where almost 
the whole cuticle was separated from the glans. The patient assur- 
ed me that it was venereal; and from the particular circumstances 
which he had related, I had no reason to think his opinion ill found- 
ed. He never had had any such complaint from connection with 
women before that time. Perhaps the disease begins oftener on 
those parts than is commonly imagined; but, being defended by a 
cuticle, they are but little susceptible of this kind of irritation; and 
this may be the reason why a permanent effect is not produced, and 
why it is often so slight as not to be observed. When the glans or 
prepuce, or both, suffer the venereal inflammation, it often rests there 
and goes no further, not being attended with a discharge of matter, 
nor with pain in the urethra. This the following case illustrates: 

A young gentleman, from Ireland, slept with a woman at Bristol; 
and a fortnight afterwards he had intercourse with another woman 
in London, which last happened to be on a Monday, and on the 
Tuesday, or the day following, he observed a discharge from the end 
of his penis when covered with the prepuce. On the Saturday fol- 
lowing he applied to me. Upon examination, I found that the run- 
ning came from the inside of the prepuce, near to the glans; and the 
corona glandis, as also that part of the prepuce which is behind it, 
appeared to be in a tender and excoriated state, and covered with 
matter. He told me he had once had a gonorrhoea before; and upon 
being asked if it was in the same place, he said it was. Not being 
certain how far this might be venereal, I made the following inquiry; 



54 OF GONORRHOEA. OHAP. I. 

whether he had been subject to such excoriations before he had vi- 
sited women? And his answer was, that he never had; and that he 
had not this complaint always after coition, but only twice as has 
been abovementioned; which, being uncommon, inclined him to sup- 
pose the elfect to be venereal. 

I suspect, that, when the prepuce swells in a gonorrhoea of the 
urethra, producing a phymosis, which is often the case, it arises from 
the same disease having affected its inside, and that, not being suffi- 
cient to produce ulceration, it goes no further. It seems probable 
that this inflammation is of the erysipelatous kind; a circumstance 
very necessary to be known in the cure. 

The urethra is the part in which this form of the venereal disease 
is most frequent; and, although the inflammation, attending the dis- 
ease in this part, has many of the common symptoms of inflamma- 
tion, yet it can hardly be called inflammatory, when moderate; at 
least it does not constantly produce all the effects of common inflam- 
mation, though there is a tendency towards it. The parts seldom 
have all the characteristic symptoms; for there is no throbbing sen- 
sation; there is but little pain, except from the irritation of the urine 
and distention of the parts; the inflammation seldom goes deeper 
ihan the surface; and we have therefore rarely any tumefaction or 
thickening of the parts. It should rather seem to be an error loci 
on the Surface of the urethra, like a blood-shot eye. 

The secretion of pus with so little inflammation, is perhaps owing 
to these parts being naturally in a state of secretion; therefore the 
transition from an healthy to a diseased secretion is more easily pro- 
duced. It sometimes happens, however, that the parts do inflame 
considerably, and the inflammation goes deep into the cellular, or 
rather reticular membrane of the corpus spongiosum urethrae, espe- 
cially near the glans. Sometimes it extends further along the cor- 
pus spongiosum urethral, producing tumefaction, that is, an extrava- 
sation of the coagulable lymph, which is the common cause of chor- 
dee. It may be observed, in general, that in most cases when suppu- 
ration is produced, there is a decrease of inflammation. The inflam- 
mation in the reticular membrane of the surrounding parts would ap- 
pear not to be always confined to the adhesive stage; for in those 
parts we have sometimes suppurations, especially in the perineum, 
which suppurations I suspect to be in the glands, as will be taken 
notice of hereafter. 

The gonorrhoea does not always attack an urethra otherwise sound; 
nor does it always attack an urethra the relative parts of which are 
always sound. Thus we find people contracting this disease while 
they are affected with strictures, a swelled prostate gland, as also 
diseased testicles, or such testicles as very readily run into disease- 
by which the malady becomes more complicated, and requires more 
attention in the method of cure. Sometimes such diseases are re- 
lieved by the gonorrhoea, at other times increased. 



SECT. VI. OP GONORRHOEA. 55 

SECTION VI. 

Of the most Common Symptoms, and the Order of their Appearance. 

Although the irritation must always begin first, yet it is not cer- 
tain which of the symptoms, in consequence of that irritation, will 
first appear; for any one may appear singly without the others, 
though this is rarely the case. The first symptom, when carefully 
attended to, is generally an itching at the urethra, sometimes ex- 
tending over the whole glans;* a little fulness of the lips of the ure- 
thra; the effects of inflammation are next observable, and soon after 
a running appears; the itching changes into pain, more particularly 
at the time of voiding the urine; there is often no pain till sometime 
after the appearance of the discharge, and other symptoms; and in 
many gonorrhoeas there is hardly any pain at all, even when the 
discharge is very considerable; at other times a pain, or rather a 
great degree of soreness, will come on long before any discharge ap- 
pears. 

There is generally at this time a greater fulness in the penis, and 
more especially in the glans, although it is not near so full as when 
erected, being rather in a state of half-erection. Besides this ful- 
ness, the glans has a kind of transparency, especially near the be- 
ginning of the urethra, where the skin is distended, being smooth and 
red, resembling a ripe cherry; this is owing to the reticular mem- 
brane, at this time loaded with a quantity of extravasated serum, and 
the vessels filled with blood. Near the beginning of the urethra 
there is in many cases an evident excoriation, which is marked by 
the termination of the cuticle all around. The surface of the glans 
also is often in an half-excoriated state, which gives it a degree of 
tenderness; and there oozes out from it a kind of matter, as has been 
before observed. The canal of the urethra becomes narrower, which 
is known by the stream of the urine being smaller than common. 
This proceeds from the fulness of the penis in general, and from the 
internal membrane of the urethra being swollen by the inflammation, 
and also from its being in a spasmodic state. Besides these changes, 
the fear of the patient, whilst voiding his urine, assists in diminishing 
the stream of urine. The stream, as it flows from the urethra, is ge- 
nerally much scattered and broken as soon as it leaves the passage, 
which is owing to the internal canal having become irregular, and is 
not peculiar to a venereal gonorrhoea, but common to every disease 
of the urethra, that alters the exact and natural figure of the canal, 

• These symptoms are most carefully observed by those who are under ap- 
prehensions of having the disease, and therefore are attentive to every little ser 
fcation about those parts. 



56 OF GONORRHOEA. CHAP. I. 

even although the irregularity is very far back. This we find in many 
diseased prostate glands. 

There is frequently some degree of haemorrhage from the urethra. 
This I suppose arises from the distention of the vessels, more es- 
pecially when there is a chordee, or a tendency to one. 

There are often small swellings observable along the lower suriacc 
of the penis in the course of the urethra. These, I suspect, are the 
glands of the urethra so enlarged as to be plainly felt on the outside. 
They inflame so much in some cases as to suppurate; and, accord- 
ing to the laws of ulceration, the matter is brought to the skin, form- 
ing one, two, or more abscesses along the under surface of the ure- 
thra, and some of these breaking internally, form what are called in- 
ternal ulcers. I have observed in several cases a tumour on the un- 
der side of the penis, where the urethra is, which would swell at 
times very considerably, even to the size of a small flattened nut, in- 
flame, and then, a gush of matter flowing from the urethra, would 
almost immediately subside. The discharge has continued for some 
time, gradually diminishing till it has entirely gone off, and the tu- 
mour has been almost wholly reduced; yet after some months it has 
swelled in the same manner again, and terminated in the same way. 
How far these tumours, and the matter they discharge, are really ve- 
nereal when they appear first, may be doubtful; and it is difficult to 
determine this, for the patients in general have recourse to medicine 
immediately; but in their subsequent attacks they are certainly not 
venereal, for they cure themselves. 

I have suspected these tumours to be the ducts or lacunae of the 
glands of the urethra distended with mucus, from the mouth of the 
duct being closed in a manner similar to what happens to the duct 
leading from the lachrymal sack to the nose; and in consequence of 
the distention of the ducts or lacunae, inflammation and suppuration 
come on, and ulceration takes place, which opens a way into the 
urethra; but this opening soon closes up and occasions a return. 
Cowper's glands have been suspected to inflame, and hardness and 
swelling have been felt externally very much in the situation of 
them, which, coming to suppuration, have produced considerable ab- 
scesses in the perinaeum. These tumours break either internally or 
externally, and sometimes in both ways, making a new passage for 
the urine, called fistulas in perinaeo. 

A soreness is often felt by the patient all along the under side of 
the penis, owing to the inflamed state of the urethra. This soreness 
often extends as far as the anus, and gives great pain, principally in 
erections ; yet it is different from a chordee, the penis remaining 
straight. 

Erections are frequent in most gonorrhceas. These, arising from 
the irritation at the time, often approach to a priapism, especially 
when there is the above-mentioned soreness, or when there is a 
chordee. 



SECT. VII. OF GONORRHOEA. 57 

Priapisms often threaten mortification in men ; and I have seen 
an instance of it in a dog. The erection never subsided, and the 
glans penis could not be covered by the prepuce, from the swelling of 
the bulb. The penis mortified and dropped off; the bone in it was 
denuded, and an exfoliation followed. As opium is of great service 
in priapism, there is reason to suppose the complaint is of a spasmodic 
nature. 

Nothing can exceed the accuracy or minuteness of description in 
this and the subsequent paragraphs. 



SECTION VII. 

Of the Discharge. 

The natural slimy discharge from the glands of the urethra is first 
changed from a fine transparent ropy secretion, to a watery, whitish 
fluid; and the natural exhaling fluid of the urethra, which is intended 
for moistening its surface, and which appears to be of the same kind 
with that which lubricates cavities in general, becomes less transpa- 
rent; and both these secretions becoming gradually thicker, assume 
more and more the qualities of common pus. In some cases of gonor- 
rhoea, the glands that produce the slime, which is secreted in conse- 
quence of lascivious ideas, are certainly not affected; for I have seen 
cases, when, after the passages had been cleared of the venereal mat- 
ter by making water, the pure slime has flowed out of the end of the 
penis on such occasions. When this matter is more in quantity than 
what lubricates the urethra, it is forced out of the orifice by the peris- 
taltic action of that canal, and appears externally.* 

The matter of gonorrhoea often changes its colour and consistence, 
which is owing to the disposition of the parts which form it; some- 
times from a white to a yellow, and often to a greenish colour. These 
changes depend on the increase or decrease of the inflammation, and 
not on the poisonous quality of the matter itself; for any irritation on 
these parts, equal to that produced in a gonorrhoea, will produce the 
same appearances; and the changes in the colour of the matter are 
chiefly observable after it has been discharged upon a cloth and be- 

* That the urethra lias considerable powers of action is evidentin a vast num- 
ber of instances ; and that action is principally from behind forwards. We find 
that a bougie may be At 'keel out by the action of the urethra. This action, I 
believe, is often inverted, as in spasmodic stranguries [and also when bougies 
have beer, retracted into the urethra. AX 

H 



58 OF GONORRHOEA. CHAP. !• 

come dry. The appearance upon the cloth is of various hues; in the 
middle the matter is thicker or more in quantity, and it is therefore 
generally of a deeper colour; the circumference is paler, because the 
watery or serous part of the matter has spread further, and at the outer 
edge of all it is darkest; this last appearance is owing to its being 
only water with a little slime, in which some of the tinge is suspend- 
ed; which, when dry, gives a transparency to the part, that takes oft 
from the white colour of the linen. It is very probable that there is 
a small extravasation of red blood in all the cases where the matter 
deviates from the common colour, and to this the different tinges 
seem to be owing. As this matter arises from a specific inflamma- 
tion, it has a greater tendency to putrefaction than common matter 
from a healthy sore, and has often a smell seemingly peculiar to 
itself. 

As it should appear that there is hardly a sufficient surface of the 
urethra inflamed to give the quantity of matter that is often produced, 
especially when we consider that the inflammation does in common 
go no further than two or three inches from the external orifice, it is 
natural to suppose that the discharge is produced from other parts, 
the office of which is to form mucus for natural purposes, and which 
are therefore more capable of producing a great quantity upon slight 
irritations, which hardly rise to inflammation. These parts, I have 
observed, are the glands of the urethra. In many cases where the 
glands have not been after death so much swelled as to be felt exter- 
nally; and where I have had an opportunity of examining the urethra 
of those who have had this complaint upon them, I have always 
been able to discover, that the ducts or lacunas leading from them 
have been loaded with matter, and more visible than in the natural 
state. I have observed, too, that the formation of the matter is not 
confined to these glands entirely; for the inner surface of the urethra 
is commonly in such a state as not to suffer the urine to pass without 
considerable pain; and therefore most probably this internal mem- 
brane is also affected in such a manner as to secrete a matter. 

This discharge in common cases should seem not to arise much 
further back in the urethra than where the pain is felt, although it 
is commonly believed that it comes from the whole of the canal, and 
even from Cowper's glands and the prostate, and even what are 
called the vesiculae seminalcs.* But the truth of this I very much 
doubt. My reasons for supposing that it comes only from the surface, 
where the pain is, are the following: If the matter arose from the 
whole surface of the urethra, and from the glands near the bladder, 
there would certainly be many other symptoms than do actually oc- 
cur; for instance, if all the parts of the urethra beyond the bulb, or 

* Those bags are certainly not reservoirs for the semen. The difference be- 
tween the contents of them and the semen gave me the first suspicion of this , 
and from several experiments on the human body, as also a comparative view 
of them in other animals, I have been able to prove that they are net. 



SECT. VIII. OF GONORRHCEA 59 

even in the bulb, were affected so as to secrete matter, that matter 
would be gradually squeezed into the bulb as the semen is, and from 
thence it would be thrown out by jerks; for Ave know that nothing 
can be in the bulbous part of the urethra, without stimulating it to 
action, especially when in a state of irritation and inflammation. In 
such a state we find that even a drop of urine is not allowed to rest 
there; and also if an injection of warm water only is thrown into the 
urethra as far as the bulb, the musculi acceleratores are uneasy till 
they act, and throw it out. Hence it is natural to suppose, that, if 
the membranous and bulbous part of the urethra, with the vesicular 
seminales, prostate, and Cowper's glands, assisted in forming the 
matter, whenever it collected in the bulb, it would probably be im- 
mediately thrown forwards by the muscles above mentioned, and we 
should be sensible of it every moment of the day. But such symp- 
toms are seldom observed. Sometimes, indeed, a spasmodic con- 
traction of these muscles occurs, which may probably arise from this 
cause, though it is more frequently felt immediately after the urine 
is discharged. 

When the inflammation is violent, it often happens that some of 
the vessels of the urethra burst, and a discharge of blood ensues, 
which is in greater quantity at the close of voiding urine. This, 
however, happens at other times, and generally gives temporary ease. 
Sometimes this blood is in small quantity, and only gives the matter 
a tinge; as I observed when treating of the colour of the discharge. 
The erections of the penis often stretch the parts so much as to be- 
come a cause of an extravasation of blood. This extravasation ge- 
nerally increases the soreness at the time of emptying the bladder, 
and in such a state of parts the urethra is usually sore when pressed ; 
jpel the bleeding diminishes the inflammation, and often gives rose. 



SECTION VIII. 

Of the Chordee. 

The chordee appears to be inflammatory in some cases, and spasmo- 
dic in others; we shall treat first of the inflammatory chordee. 

When the inflammation is not confined merely to the surface of 
the urethra and its glands, but goes deeper and affects the reticular 
membrane, it produces in it an extravasation of coagulable lymph, 
as in the adhesive inflammation, which, uniting the cells together, 
destroys the power of distention of the corpus spongiosum urethrae, 
and make it unequal in this respect to the corpora cavernosa penis, 
and therefore a curvature takes place in the time of erection, which 



60 OF GONORRHOEA CHAP. I. 

is called a chordee. The curvature is generally in the lower part of 
the penis, arising from the cells of the corpus spongiosum urethrae 
having their sides united by adhesions. Besides this eifcct of inflam- 
mation, when the chordee is violent, the inner membrane is, I sup-, 
pose, so much upon the stretch, as to be in some degree torn, which 
frequently causes a profuse bleeding from the urethra, that often 
relieves the patient, and even sometimes proves the cure. As chordee 
arises from a greater degree of inflammation than common, it is an 
effect which may, and often does, remain when all infection is gone, 
being merely a consequence of adhesive inflammation. 

This explanation of chordee is perfectly consistent with our know- 
ledge of the process of inflammation. If adhesions have taken place 
in the neighbourhood of the urethra, to prevent the spreading of the 
inflammation, the net-work, which should adapt itself to the quan- 
tity of blood it receives during erection, has become more rigid. 
The inconvenience arising from this will not be perceived in the re- 
laxed state of those parts, but when turgid with blood, it must render 
such turgescence unequal, and by stretching the more rigid or ad- 
herent cells, must produce pain. As these adhesions continue for 
some time after the inflammation has ceased, so chordee is a com- 
mon sequela of gonorrhoea, especially in young subjects, or in those 
to whom the venereal infection is new, and the inflammation great 
in proportion. The disease can only be removed by the absorption 
of the extravasated lymph, or by the elongations of the connecting 
fibres, either of which processes must be slow. 

There is an obscurity in the concluding three lines of this section, 
arising, I suspect, from some error in the punctuation. It is also 
worthy of remark, that Mr. Hunter gives no account of spasmodic 
chordee. 



SECTION IX. 

Of the Manner in which the Inflammation attacks the Urethra. 

In what manner the disease extends itself to the urethra, is a 
question not yet absolutely determined. I suspect that it is commu- 
nicated, or creeps along from the glans to the urethra, or at least 
from the beginning or lips of the urethra to its inner surface; be- 
cause it is impossible to conceive, that any of the venereal matter 
from the woman can get into the canal during coition, although the 
contrary is Commonly asserted. It is impossible at least that'it can 
get so far as the common seat of the disease, or into those parts of 



SECT. IX. OP GONORRHOEA. 61 

the urethra where it very often exists, that is, through the whole 
length of the canal. The following case amounts to a proof of this 
opinion. 

A gentleman, on whose veracity I have an entire confidence, 
when in Germany, where he had not lain with a woman for many 
weeks, sat in a necessary-house some time. Upon arising, he found 
something that seemed to give the glans penis a little sharp pull, and 
he found a small bit of the plaster of the necessary-house sticking to 
it. He paid no further attention to it at that time than merely to re- 
move what stuck to his penis; but five or six days after, he observed 
the symptoms of a clap, which proved a pretty severe one. The only 
way of accounting for this is, that some person who had a clap had 
been there before him, and had left some venereal matter upon this 
place, and that the penis had remained in contact with it a sufficient 
time for the matter to dry. 

When the disease attacks the urethra, it seldom extends further 
than an inch and a half, or two inches at most, within the orifice, 
which distance appears to be truly specific, and what I have called 
the specific extent of the inflammation.* 

As the cause of a gonorrhoea is commonly an inflammation, it is 
accompanied with pain and the formation of matter. In such a state 
neither the sensations of the patient, nor the actions of the parts 
themselves, are confined to the real seat of the disease. In conse- 
quence of the neighbouring parts sympathizing, a variety of symp- 
toms are produced, many of which do not exceed what might arise 
from an irritable state; an uneasiness partaking of soreness and 
pain, and a kind of weariness, are every where felt about the pel- 
vis: the scrotum, testicles, perinaeum, anus, and hips, become disa- 
greeably sensible to the patient; and the testicles often require being 
suspended; and so irritable are they indeed in such cases, that the 
least accident, or even exercise, which would have no such enVc at 
another time, will make them swell. The glands of the groin are 
often affected sympathetically, and even swell a little, but do not 
come to suppuration. When they inflame from the absorption of 
matter, they in general suppurate. I have seen cases where the ir- 
ritation has extended so far as to affect with real pain the thighs, the 
buttocks, and the abdominal muscles, so that the patient has been 
obliged to lie quiet in a horizontal position. The pain has at times 
been very acute, and the parts have been very sore to the touch: 
they have- even swelled, but the swelling has not been of the inflam- 
matory kind; for, notwithstanding a visible 'fulness, the parts have 
been rather soft. I knew one gentleman who never had a gonor- 

« It is to be here remarked, that specific diseases, among which I shall rec- 
kon such as arise from morbid poisons, have their specific distance or extent as 
one of their properties; but this can only take place where the constitution is 
not susceptible of erysipelas, or any other uncommon mode of action ; tor where 
'here is an erysipelatous disposition no bounds are set to the inflammation. 



62 OF GONORRHOEA. CHAP. I. 

rhoea, but that he was immediately seized universally with rheuma- 
tic pains. This had happened to him several times. The blood at 
such times is generally free from the inflammatory appearance, and 
therefore we may suppose that the constitution is but little affected. 

When the gonorrhoea (exclusive of the affections arising from 
sympathy) is not more violent than I have described, it may be called 
common or simple venereal gonorrhoea; but if the patient is very sus- 
ceptible of such irritation, or of any other mode of action which 
may accompany the venereal, then the symptoms are in proportion 
more violent. In such circumstances we sometimes find the irrita- 
tion and inflammation exceed the specific distance, and extend 
through the whole of the urethra. There is often also a considerable 
degree of pain in the perinaeum, and a frequent, though not a con- 
stant, symptom is a spasmodic contraction of the acceleratoves urinae, 
which is always attended with contractions of the erectores muscles. 
Whether these spasms arise from a secretion of matter, which, being 
collected in the bulbous part of the urethra, produces uneasiness, and 
excites contractions in order to its own expulsion, like the last drops 
of urine, I have not been able to determine. I have seen such spasms 
in the time of making water, from the urine irritating the parts in its 
passage through the urethra, and throwing the musculi acceleratores 
into contractions, so that the water has come by jerl«. This kind of 
inflammation sometimes is considerable, goes deep into the cellular 
membrane, and produces tumefaction without any other effect. In 
other cases it goes on to suppuration, often becoming one of the causes 
of fistulas in perinaeo. I have sometimes, as I have already observed, 
suspected Cowper's glands to be the seat of such suppurations; for 
I have observed externally, circumscribed swellings in the situation 
cf those glands. The small glands likewise of the bulbous part of 
the urethra may be affected in a similar manner; and the irritation is 
often extended even to the bladder itself. 

When the bladder is affected, it becomes more susceptible of 
every kind of irritation, so that very disagreeable symptoms are 
oilen produced; it will not allow of the usual distention, and there- 
fore the patient cannot retain his water the ordinary time; and the 
moment the desire of making water takes place, he is obliged hit 
stantly to make it with violent pain in the bladder, and still more 
in the glans penis, exactly similar to what happens in a fit of the 
stone. If the bladder be not allowed to discharge its contents im- 
mediately, the pain becomes almost intolerable; and even when the 
water is evacuated there remains for some time a considerable pain 
both in the bladder and glans; because the very contraction of the 
muscular coat of the bladder becomes a cause of pain. 

The ureters, and even the kidneys sometimes sympathize, when 
the bladder is very much inflamed, or under a considerable degree of 
irritation; however this but rarely happens. I have even reason to 
suspect that the irritation may be communicated to the peritonaeum 



SECT. IX. OF GONORRHOEA. 63 

by means of the vas deferens. This suspicion receives some con- 
firmation from the following history. A gentleman had a gonorrhoea 
which was treated in the antiphlogistic way. The discharge being 
in some degree stopped, a tension came upon the lower part of the 
belly on the right side, just above Poupart's ligament, but rather 
nearer to the ilium. There was hardness and soreness to the touch, 
which soreness spread over the whole belly, producing rigors every 
third day, with a low pulse, which to me indicated a peritonaeal in- 
flammation, arising, in my opinion, from the vas deferens of that 
side being affected in its course through the belly and pelvis. 

When the inflammation, or perhaps only the irritation, runs along 
the whole surface of the urethra, attacks the bladder, and even ex- 
tends to the ureters and the kidneys, so as to cause a disagreeable 
sensation in all these parts, the disease is generally very violent, and, 
I suspect, is something of the erysipelatous kind. At least it shows 
an irritable sympathizing habit. 

This disease sometimes produces very uncommon symptoms. A 
gentleman had a gonorrhoea; and, when the inflammatory symptoms 
were abating, the urethra lost both the involuntary and voluntary 
powers of retaining the urine. His water came away involuntarily; 
•nor could he stop it. I advised him to do nothing, and to wait for 
some time, as probably the method of cure might be more disagree- 
able than the disease itself, although it was very troublesome to him 
when in company. The complaint gradually lessened, and in time 
went entirely off. 

The case in the second paragraph of this section would show, that 
gonorrhoea may be occasioned by matter applied only to the glans pe- 
nis; but it does not necessarily follow, that infectious matter never 
proceeds higher; however, that it does not, almost amounts to proof; 
because, during the usual process of the actus coccus, the expulsive 
power of the urethra is never inverted without disease; and, without 
this inversion, matter could not advance up that canal. 

By the paragraph to which the note is annexed, we see the specific 
distance marked, which under common degrees of inflammation is 
preserved, unless the kind of inflammation should, from some pecu- 
liarity of 'constitution, be changed from the adhesive. The subse- 
quent paragraph refers only to sympathetic affections not partaking 
of inflammation. 

After which, Mr. Hunter shews, that the consequence of very high 
inflammation, whether erysipelatous or not, may be sufficient to de- 
stroy the specific distance to which the constitution can at other times 
confine the irritation from this poison. This has been already illus- 
trated bv the effrts of greater or less violent inflammation in small- 
pox. 



64 6P GONORRHOeA. CtfAP. I. 

SECTION X. 

Of the Swelled Testicle. 

A very common symptom attending a gonorrhoea is a swelling of 
the testicle. This, I believe, like the affection of the bladder, and 
many of the symptoms mentioned before, is only sympathetical, and 
not to be reckoned venereal, because the same symptoms follow every 
kind of irritation on the urethra, whether produced by strictures, 
injections, or bougies. It may be observed here, that those symp- 
toms are not similar to the actions arising from the application of the 
true venereal matter, whether by absorption or otherwise; for they 
seldom or ever suppurate; and when suppuration happens, the mat- 
ter produced is not venereal. 

The testicles seem, as it were, in many cases, rather to be acting 
for the urethra, than for themselves, which is an idea applicable to 
all sympathies. Thus the swelling and inflammation appears sud- 
denly, and as suddenly disappears, or in a few minutes goes from 
one testicle to the other; the affection depending upon the state of the 
urethra, and not at all upon the part itself. A part, however, of the 
testicle, the epididymis, assumes all the characters of inflammation, 
remaining swelled even for a considerable time after the inflamma- 
tion has subsided. 

The first appearance of swelling in the testicle is generally a soft 
pulpy fulness of the body of the testicle, which is tender to the 
touch; this increases to a hard swelling, accompanied with consider- 
able pain. The hardest part is generally the epididymis, and prin- 
cipally that portion of it which is at the iower end of the testicle, as 
may be distinctly felt. The hardness and swelling, however, often 
run the whole length of that body, and form a knob at the upper 
part. The spermatic cord is likewise often affected, and more espe- 
cially the vas deferens, which is thickened and sore to the touch. 
The veins of the testicle sometimes become varicose. I have seen 
such a state of veins accompanying a swelling of the testicle in two 
instances. A pain in the small of the back generally attends inflam- 
mations of the testicle of all kinds, with a sense of weakness of the 
loins and pelvis. The bowels generally sympathize with most com- 
plaints of the testicle, in some by cholicky pains, in others by an un- 
common sensation both in the stomach and intestines. Sickness is 
a common symptom, and even vomiting; the powers of digestion by 
this means are impaired, and a disposition for the accumulation of 
air takes place, which is often very troublesome. Here we have 
from the testicles a chain of sympathies, as we had in consequence 
of the irritation running along the whole urinary passages, first the tes- 
ticle is affected from the urethra, then the spermatic chord, the loins 



SECT. X. OF GONORRHOEA. 65 

intestines, stomach, and from thence in some measure the whole 
body. 

In a case of swelled testicle I have known the buttocks swell, but 
the swelling was not of the inflammatory kind, and in making water, 
pain was felt in that part. Whether this symptom arose from the 
swelling of the testicle, or from the same common cause, that is, the 
gonorrhoea, is not easily determined; although the latter supposition 
is the most probable. 

It has been asserted, but without proof, that in cases of swelled 
testicles in consequence of a gonorrhoea, it is not the testicle that 
6wells, but the epididymis. The truth is, it is both the one and 
the other. Any man that is accustomed to distinguish between 
a swelling of the whole testicle, and that of the epididymis only, 
will immediately be sensible, that in the hernia humoralis the 
whole testicle is swelled. The testicle assumes the same shape that 
it does from other causes, where we know, from being obliged to re- 
move it, that the whole has swelled. The pain is in every part 
of the testicle. I have seen such swellings suppurate on the fore- 
part, and have known several instances of adhesions between the 
tunica albuginea and vaginalis, from such causes. This has only 
been discovered after death, or in the operation for a partial hydro- 
cele. Such changes could not have taken place if the body of the 
testicle had not been in a state of inflammation. This inflammation 
of the testicle most probably arises from its sympathizing with the 
urethra, and in many cases it would appear to arise from what is un- 
derstood by a translation of the irritation from the urethra to the tes- 
ticle. Thus a swelling of the testicle coming on shall remove the 
pain in making water, and suspend the discharge; which shall not 
return till the swelling of the testicle begin to subside; or the ir- 
ritation in the urethra first ceasing shall produce a swelling of the 
testicle, which shall continue till the pain and discharge return; thus 
rendering it doubtful which is the cause and which the effect. I 
have nevertheless known cases, where the testicle has swelled, and 
yet the discharge has become more violent; nay I have seen instances 
where a swelling has come on after the discharge has ceased; yet 
the discharge has returned with violence, and remained as long as 
the swelling of the testicle. Sometimes the epididymis only is af- 
fected, sometimes the vas deferens, and at other times only the sper- 
matic chord, producing varicose veins. No reason can be assigned 
why one of these parts is affected more than another, and indeed the 
immediate cause in all is as yet unknown. For although an action 
in the urethra is the remote cause, yet it is still impossible to say 
whether it be the cessation of that action that is the cause of the 
swelling in the testicle, or the swelling in the testicle the cause of the 
cessation. It is described as arising from an irritation taking place 
in the mouths of the vasa deferentia. Were this the cause, it ought 
in gcnernl to n fleet both testicles at the same time: but I have seen 

7 



6G OP GONORRHOEA. CHAP. I. 

this complaint happen as. often where the inflammation has gone no 
further back in the urethra than about an inch and a half, or two 
inches, as where it has extended further; and the circumstance of the 
swelling shifting suddenly from one testicle to the other, shows it to 
arise from some other principle in the animal economy. 

A strangury often attends such cases of sympathy, and more fre- 
quently when the running stops, than when it is continued along with 
the swelling of the testicle. Indeed any sudden stopping of the dis- 
charge gives a tendency to a strangury. 

As singular a circumstance as any respecting the swelling of the 
testicle is, that it does not always come on when the inflammation in 
the urethra is at the height. I think it oftener happens when the ir- 
ritation in the urethra is going off; and sometimes even after it has 
entirely ceased, and when the patient conceives himself to be quite 
well. 

I may be allowed to remark that swellings in the testicle in con- 
sequence of venereal irritation in the urethra, subject it to a suspicion 
that every swelling of this part is venereal: but from what I said of its 
nature when it arises from a venereal cause, which was that it is ow- 
ing to sympathy only, and from what I shall now say, that it is never 
affected -with the venereal disease either local or constitutional, as far 
as my observation goes, it is to be inferred that such suspicions are 
always ill founded. This, perhaps, is an inference to which few will 
subscribe. 

I have known the gout produce a swelling in the testicle of the 
inflammatory kind, and therefore similar to the sympathetic swelling 
from a venereal cause, having many of its characters. Injuries done 
to the testicle produce swellings: but they are different from those 
above mentioned, being more permanent, having the disease or cause 
in the part itself. Cancers and the scrofula produce swellings of the 
testicle; but these are generally slow in their progress, and not at all 
similar to those arising from an irritation in the urethra. 



SECTION XI. 

Of tlie Swellings of the Glands from Sympathy. 

Since our knowledge of the manner in which substances »et mto 
the circulation, and our having learned that many substances, espe- 
cially poisons, in their course to the circulation, irritate the absorbent 
glands to inflammation and tumefaction, we might naturally suppose 
such swellings, accompanying complaints in the urethra attended with 
a discharge, to be owing to the absorption of that matter, and there- 



S ECT. XI. OF GONORRHOEA. 67 

fore, if it be a venereal discharge, that they must also be venereal. 
But we must not be too hasty in drawing this conclusion; for we 
know that the glands will sometimes swell from an irritation at the 
origin of the lymphatics, where no absorption could possibly have 
taken place. They often swell and become painful upon the com- 
mencement of inflammation, before any suppuration has taken place, 
and subside at the coming on of suppuration; because, when the sup- 
puration begins, the inflammation abates. I have known a prick in 
the finger with a clean sewing-needle produce a red streak all up the 
fore arm, pain along the inside of the biceps muscle, a swelling of the 
lymphatic gland above the inner condyle of the humeris, and also of 
the glands of the arm-pit, immediately followed by sickness and a 
rigor; all which, however, have soon gone off. As it should therefore 
appear, that the absorbent system is capable of being affected as well 
by irritation, as by the absorption of matter, in all diseases of this 
system, arising from local injuries attended with matter, one must 
always have these two causes in view, and endeavour, if possible, to 
distinguish from which the present affection proceeds. For in those 
arising from an irritated surface in consequence of poison, especially 
the venereal, it is of considerable consequence to be able to say from 
which of the two it arises; since it sometimes happens, although but 
seldom, that the glands of the groin are affected in a common gonor- 
rhoea with the appearance of beginning buboes, but which I suspect to 
be similar to the swelling of the testicle, that is, merely sympathetic. 
The pain they give is but very trifling, when compared to that of the 
true venereal swellings arising from the absorption of matter; and 
they seldom suppurate. However, there are swellings of these glands 
from actual absorption of matter in gonorrhoea, and which conse- 
quently are truly venereal; and as it is possible to have such, they are 
always to be suspected. As they have sometimes arisen upon a ces- 
sation of the irritation in the urethra, similar to the swelling of the 
testicle, it has been supposed that the matter was driven as it were 
into them by unskilful treatment. From our acquaintance with the 
absorbing system, we know that the matter can go that way; but we 
also know, that we have no method of driving it that way; and if we 
had, there is no reason why more should not be formed in the ure- 
thra. This, therefore, does not account for the cessation of secretion 
of matter in that part. 

It is difficult to say, what is the nature of those sympathetic dis- 
eases. They are not venereal, for they subside by the common 
treatment of inflammation without the use of mercury; and I have 
known an instance of a swelled testicle from a venereal gonorrhoea 
that suppurated, and was treated by my advice as a common suppu- 
ration, and healed without a grain of mercury being given. Neither 
can they be called truly inflammatory, having rarely any of the true 
characters of inflammation, such as thickening of the parts, symptom- 
atic fever, or sizy blood, except in swellings of the testicle and 



68 OP GONORRHOEA, CHAP. U 

glands. The swelling of the testicle has several peculiarities attend- 
ing it; it is often very quick in its increase, and not being of the 
true inflammatory disposition, it requires less time for the removal 
of the inflammation; but even where it appears to have more of the 
true inflammatory action, we find that the removal of the inflamma- 
tion and tumefaction take place more rapidly than when proceeding 
from other causes. A swelled testicle, in consequence of the radical 
cure of the hydrocele, does not subside after inflammation is gone, 
in as many weeks, as the swelled testicle, in consequence of its 
sympathy with other parts, does in days; and probably the reason of 
this is, that it arises from sympathy: for an inflammation arising 
from real disease in a part, or from an external injury, as in the hy- 
drocele, must always last either till the disease be removed, or the 
injury repaired; but that from sympathy will vary as the cause va- 
ries, which may happen very quickly; for we find a testicle swell 
in a few minutes, and in as little time subside; and also the swelling 
move suddenly from one testicle to the other. These sympathies 
are often peculiar to constitutions, and even to temporary constitu- 
tions, insomuch as to be in some degree epidemic; for there is often 
such an influence in the atmosphere, as predisposes the body to this 
kind of irritation; and bodies so predisposed require only the im- 
mediate cause to produce the effect. 



SECTION XII. 

Of the Diseases of the Lymphatics in a Gonorrhoea. 

Another symptom, which sometimes takes place in gonorrhoea, is- 
a hard chord leading from the prepuce, along the back of the penis, 
and often directing its course to one of the groins, and affecting the 
glands. There is most commonly a swelling in the prepuce at the 
part where the chord takes its rise. This happens sometimes when 
there is an excoriation and discharge from the prepuce or glans 
which may be called a venereal gonorrhoea of these parts. Both the' 
swelling in the groin, and the hard chord, we have reason to suppose, 
arise from the absorption of pus, and therefore that they are the first 
steps towards a lues venerea; but as that form of the disease seldom 
happens from a gonorrhoea, I shall not take any further notice of it 
in this place. However, I may remark, that from this observation of 
the lues venerea being seldom produced from a gonorrhoea, it should 
appear that a whole surface, or one only inflamed, does not readily 
admit of the absorption of the venereal poison; and therefore al- 
though the venereal matter lies for many weeks in the passage 'and 



SECT. XIII. OF GOX0RXHCEA. 69 

over the whole glans, it seldom happens that any absorption takes 
place. I have seen a case, where blood has been discharged from 
the urethra, and the above-mentioned symptoms have come on. I at 
first suspected that the absorption had taken place where the vessel 
gave way. But as this symptom rarely happens, even where there 
has been a considerable discharge of blood, I am inclined to think 
that wounds are also bad absorbing surfaces, especially when I con- 
sider that few morbid poisons are absorbed from wounds. 



These appearances are very accurately marked by Turner, though 
he was unable to form a just conjecture of their cause, 



SECTION XIII. 

Short Recapitulation of the Varieties in the Symptoms-. 

From what has been advanced above, it must appear that the va- 
riety of symptoms in a gonorrhoea, and the difference of them in dif- 
ferent cases, are almost endless. I shall now recapitulate a few oi 
the most material or common varieties. The discharge often ap- 
pears without any pain; and the coming on of the pain is not at any 
stated time after the appearance of the discharge. There is often no 
pain at all, although the discharge be considerable in quantity, and 
of a bad appearance. The pain often goes off, while the discharge 
continues, and will sometimes return again. An itching in some 
cases is felt for a considerable time, which sometimes is succeeded 
by pain; though in many cases it continues to the end of the disease. 
On the other hand, the pain is often troublesome, and considerable 
even when the discharge is trifling, or none at all. In general, the 
inflammation in the urethra does not extend beyond an inch or two 
from the orifice; sometimes it runs all along the urethra to the blad- 
der, and even to the kidneys, and in some cases spreads into the 
substance of the urethra, producing a chordee. The glands of the 
urethra inflame, and often suppurate; and I suspect that Cowper's 
glands sometimes do the same. The neighbouring parts sympathize, 
as the glands of the groin, the testicle, the loins, and pubes, with the 
upper parts of the thighs and abdominal muscles. Sometimes the 
disease appears soon after the application of the poison, as in a few 
hours, at other times not till after six weeks. It is often not possible 
to determine whether it is venereal, or only an accidental discharge 
arising from some unknown cause. 

It may not be improper to mention here, that I have seen a chancre 



70 OF GONORRHOEA. CHAP. H. 

on the prepuce produce a pain in the urethra in making water ; 
which most probably depended upon a sympathy similar to that by 
which the application of venereal matter to the glans produces a dis- 
charge from the urethra, as was observed above. If the application 
of venereal matter to the glans can produce a discharge from the ure- 
thra, it is possible that any acrid matter, though not venereal, may 
have a similar effect. The discharge from the vagina, in cases of 
what is called fluor albus, is sometimes extremely irritating, inso- 
much as to excoriate the labia and thighs; and the following history 
shews that it may sometimes produce effects similar to venereal 
matter. 

Mr. and Mrs. have been married these twenty years and 

upwards. She has for many years past been at times troubled with 
the fluor albus. When he has connexion with her at such times, it 
generally, although not always, produces an excoriation of the glans 
and prepuce, and a considerable discharge from the urethra, attend- 
ed with a slight pain. These symptoms commonly take a consider- 
able time before they go off, whether treated as a gonorrhoea or as a 
weakness. Is this a new poison? And does it go no further be- 
cause the connexion takes place only between two? What would be 
the consequence if she were to have connexion with other men, and 
these with other women? Such cases, as far as I have seen, have 
only been in form of a gonorrhcea. They have not produced sores 
in the parts ; nor, as far as I know, do they ever produce constitu- 
tional diseases. 



This is one case in which gonorrhoea was traced to such a cause, 
as precluded all reasonable suspicion of a venereal origin, and may 
explain the reason why the secondary symptoms of the disease, or 
what is called lues venerea, occurs so rarely after gonorrhoea, com- 
pared with chancres, and also to show the uncertainty of the expe- 
riment of inoculating gonorrhceal matter. 



CHAP. II 



Of the Gonorrhoea in Women. 

The venereal disease in the form of gonorrhoea in women is not 
so complicated as in men; the parts affected are more simple, and 
fewer in number. But it is not so easily known in them as it is in 
men, because the parts commonly affected in women are very sub- 



<.HAP. II. OF GONORRHOEA. 11 

ject to a disease resembling the gonorrhoea, called Jiuar albus; and 
the distinguishing marks, if there are any, have not yet been com- 
pletely ascertained. A discharge simply from these parts in women, 
is less a proof of the venereal infection than even a discharge with- 
out pain in men; therefore, in general, little or no attention is paid 
to it by the patient herself, and we often find the venereal virus 
formed in those parts without any increase of the natural discharge. 
The kind of matter gives us no assistance in distinguishing the two 
diseases; for it often happens that the discharge in the fluor albus 
puts on all the appearances of the venereal matter; and an increase 
in the discharge is no better mark by which we can distinguish the 
one from the other. Pain, or any peculiarity in the sensations of the 
parts, is not a necessary attendant upon this complaint in women, 
therefore not to be looked for as a distinguishing symptom. 

The appearance of the parts often give us but little information, 
for I have frequently examined the part of those who confessed all 
the symptoms; such as increase of discharge, pain in making water, 
soreness in walking, or when they were touched, yet I could, see no 
difference between these and sound parts. I know of no other way 
of judging in cases where there are no symptoms sensible to 
the person herself, or where the patient has a mind to deny having 
any uncommon symptoms, but from the circumstances preceding the 
discharge; such as her having been connected with men supposed to 
be unsound, or her being able to give it to others; which last circum- 
stance, being derived from the testimony of another person, is not 
always to be trusted to, for very obvious reasons. Thus a woman 
may have this species of the venereal disease without knowing it 
herself, or without the surgeon being able to discover it even on in- 
spection. It may appear very strange, that a disease which is so vio- 
lent and well marked in men should be so obscure in women: but 
when we consider that this poison generally produces symptoms ac- 
cording to the nature of the parts affected by it, it becomes an easy 
matter to account in some measure for this difference. 

When we attend to the manner in which this disease is contracted 
by women, it is evident that it must principally attack the vagina, a 
part that is not endowed with much sensation, or action of any kind. 
While it is confined to the vagina, it may be compared to the same 
disease on the glans penis in men. In many cases, however, it ex- 
tends much further, and becomes the cause of disagreeable feelings, 
producing a considerable soreness in all the parts formed for sensa- 
tion, such as the inside of the labia, nymphae, clitoris, carunculse 
mvrtiformes, the orifice of the meatus urinarius, and often affecting 
that canal in its whole length. Those parts are so sore in some cases, 
as not to bear being touched; the person can hardly walk; the urine 
gives pain in its passage through the urethra, and when it washes 
the above-mentioned parts, which can hardly be avoided. Such 
symptoms are not much increased at one time more than another, 



72 OF GONORRHOEA. CHAP. II. 

excepting at ihe time of making water, and then principally in those 
who have the urethra affected; for as these parts are less exposed to 
circumstances of change, the increased irritation arising from such 
change of parts must necessarily in this sex be less. But in men the 
urethra, which is the part most commonly affected, has great sensi- 
bility, is capable of violent inflammation, is often distended with a 
stimulating fluid; and the body of the penis, urethra, and glans, 
stretching the passage with erections, always produce an increase of 
the symptoms, especially of the pain. 

But as this disease frequently attacks parts more sensible than the 
vagina, and which are more susceptible of inflammation, as has been 
observed, under such circumstances women have nearly the same 
symptoms as men; a fulness about the parts, almost like an inflamed 
tonsil, a discharge from the urethra, violent pain in making water, 
and great uneasiness in sitting from pressure on those parts. 

The bladder sometimes sympathizes, producing the same symptoms 
as in men, and it is probable that the irritation may be communicat- 
ed even to the kidneys. It has been asserted that the ovaria are 
sometimes affected in a similar manner to the testicles in men. I 
have never seen a case of this kind, and I should very much doubt 
the possibility of its existence; for we have no instance in other dis- 
eases of the ovaria sympathizing with those parts, or at least pro- 
ducing such symptoms as would enable us to determine that they did. 
That there do, however, uncommon symptoms now and then occur, 
should appear from the following case. 

A lady had all the symptoms of a venereal gonorrhoea, such as a 
discharge, pain, and frequency in making water, or rather a conti- 
nued inclination to void it, and a heaviness approaching to pain about 
the hips and loins. The uncommon symptom in this case was great 
flatulency in the stomach and bowels; this last sympton was most pro- 
bably a sympathy with the uterus. There may possibly be sympa- 
thies therefore with the ovaria. 

The inflammation frequently goes deeper than the surface of the 
parts; often running along the ducts of the glands, and affecting the 
glands themselves so as to produce hard swellings under the surface 
of the inside of the labia, which sometimes suppurate, forming small 
abscesses, opening near the orifice of the vagina. These are similar 
to the inflammations and suppurations of the glands in the urethra in 
men. The different surfaces, or parts which the disease attacks, 
make no distinction in the disease itself. It is immaterial whether 
it is a large or small surface: in one case the parts are more sus- 
ceptible of this irritation than in another; but the method of cure 
may be more complicated. 

It sometimes happens, that the venereal matter from the vagina 
runs down the perinasum to the anus, producing a gonorrhoea or chan- 
cres there. 

How far the gonorrhoea in women is capable of wearing itself out, 



SECT. I. Of UOJNOKKHttA. l3 

as in men, I cannot absolutely determine; but I am much inclined to 
believe that it may; for I have known many women who have got 
rid of a violent gonorrhoea without having used any means to cure it; 
and indeed the great variety of methods of cure employed in such 
cases, all of which cannot possibly do good, though the patients get 
well, seems to confirm this opinion. One circumstance, which ap- 
pears as curious as any, is the seeming continuance of the disease in 
the vagina for years; at least we have reason to believe this, as far 
as the testimony of patients can be relied on; and this long conti- 
nuance of it, without wearing itself out as it does sometimes in men, 
is probably owing to its being less violent in the vagina. 



I am far from being convinced that the true venereal gonorrhoea 
ever does wear itself, or cease by a spontaneous cure, in either wo- 
men or men. That many gonorrhoeas do cease in both sexes is cer- 
tain; but it is by no means proved that such are venereal. It may 
also be admitted that venereal gonorrhoeas may cease without the use 
of those means which are found necessary in chancres. But every 
wrong action, which the constitution caijnot change of itself, must 
be superseded by a new action proportionate to the force of the old. 
An early chancre may be cured with less mercurial excitement than 
an old one, as the disease has probably not extended so far into the 
surrounding parts. In gonorrhoea no breach of the solids has taken 
place; all therefore that is required is to supersede the action by 
which this contagious secretion is induced. Nor need this new ac- 
tion be kept up long, because we have not as we shall find in chan- 
cre a new conformation of parts, but a mere alteration in their se- 
cretion. To remove the first it may probably be necessary that the 
new parts should be absorbed, which must require more time than 
merely to supersede a diseased action. 



SECTION I. 

Of the Proofs of a Woman having this Disease. 

It may be asked, what proof there is of a woman having a gonor- 
rhoea, when she is not sensible of having any one symptom of the 
disease, and none appears to the surgeon on examination? In such 
a case the only thing \.e can depend upon is, the testimony of those 
whom we look lipomas men of veracity. Such men have asserted, 
that they have been affected by a woman in the situation above de- 
scribed," having had no connection for some months with any other 

K 



*V4 OF GONORRH(EA. CHAP. II. 

woman. From this evidence it is reasonable to suppose, that the dis- 
ease has been caught from such woman; and it should seem to put it 
beyond a doubt, when the same woman gives the disease in this way 
to "more than one man. The case of the woman giving the disease 
to two men alternately at an interval of twelve months each time,* 
which gives a space of at least two years for the continuance of the 
disease, proves that its communication is almost the only criterion of 
its presence. The case too of the young woman at the Magdalen 
Hospital,! confirms the same opinion. Yet all this does not amount 
to an absolute proof; for a sound woman may have had a connection 
with a man who had a gonorrhoea, or a man with chancres, and soon 
after, that is, perhaps within forty-eight hours, she m;<y have admit- 
ted the embraces of a sound man. In such a case it is very possi- 
ble that he may receive the infection from that matter which was 
lodged in the vagina by the unsound man; and yet the woman may 
not catch the disease; for the matter may be washed away before it 
irritates the vagina; and this woman may be suspected of having a 
gonorrhoea, and apparently with great justice. A repetition of these 
circumstances may be the cause of many women appearing to haVe 
the disease for years, when without really having it. Again, I have 
seen a bubo come on at a time when the patient was not sensible of 
any disorder till that appeared. This, one would think, is an abso- 
lute proof, that there may be a gonorrhoea, and the patient not be 
conscious of it; but even this is not altogether without fallacy; for 
they may have been an absorption of venereal matter deposited in 
the vagina by some infected man, which may not have produced any 
irritation in that part. 



The proofs of venereal gonorrhoea in women must be very uncer- 
tain, and to this it may be imputed that women have sometimes the 
secondary symptoms, or lues venerea, without our being able to trace 
the primary symptoms: when we consider the constant humidity of 
the female organs, we cannot wonder if a slight gonorrhoea, though 
venereal, should pass unnoticed. 

* See page 48. f See page 49. 



€HAP. III. OF GONORRIKEA. 75 

CHAP. III. 

Of the Effects of the Gonorrhoea on the Constitution in both Sexes. 

The disease I have been describing, both in men and women, is 
local, and generally confined to the part affected; yet it sometimes 
happens that the whole constitution is more or less affected by it. Thus 
we find, before there is any appearance of matter from the parts, 
that some patients complain of slight rigors: these are most consi- 
derable when the suppuration is late in taking place. A remarkable 
instance of this happened in a gentleman who had the infection 
twice,* the first time, he assured me, that it was six weeks between 
the time it was possible for him to have contracted the disease, and 
its appearance; and that for a considerable part of that time he had 
often been indisposed with slight rigors, attended with a little fever 
and restlessness, for which he could assign no cause; nor was he re- 
lieved by the usual remedies prescribed in such cases. A violent 
gonorrhoea came on, and these symptoms went off, which appeared to 
me to explain the case. The second time it was a month from the 
time of infection before the gonorrhoea appeared, and for some weeks 
of that time he was subject to a similar indisposition, which went off 
as before, when the running came on. Here it would appear that we 
have something of a suppurative fever, which, perhaps, often happens 
in this disease; but the inflammation being small, and the fever there- 
fore inconsiderable, it is commonly little noticed by the patient. The 
above gentleman, not suspecting any such complaint in the first at- 
tack, had connection with his wife as usual, and was afraid, when 
the disease appeared, that he might have given it to her; but she ne- 
ver complained, which is a strong circumstance in confirmatio 
the principle laid down above, that it cannot be communicated but by 
matter. 

These constitutional sympathies, from local specific diseases, are 
the same, from whatever cause they proceed; they are the sympa- 
thetic effects of irritation or of violence; and it is probable that all 
remote sympathies are, at least in this respect, similar: for if they 
were similar to their cause, it is most probable that they would pro- 
duce in the constitution the same kind of disease that gave rise to 
them. 

The case is mentioned before, page 48. 



76 OF GONORRHOEA. CHAP. IV. 

CHAP. IT. 

Of the Cure of the Gonorrhoea. 

From the idea which 1 have endeavoured to give of the venereal 
disease in general, namely, that, in whatever form it appears, it al- 
ways arises from the same cause, it might be supposed, that, since 
we have a specific for some of the forms of the disease, this specific 
should be a certain cure for every one; and therefore that it must be 
no difficult task to cure the disease when in the form of inflammation 
and suppuration upon the secreting surfaces of any of the ducts or 
outlets of the body: but from experience we find the gonorrhoea the 
most variable in its symptoms, while under a cure; and the most un- 
certain, with respect to its cure, of any of the forms of this- disease; 
many cases terminating in a week, while others continue for months, 
under the same treatment. 

The only curative object is, to destroy the disposition and specific 
mode of action in the solids of the parts, and as that is changed, the 
poisonous quality of the matter produced will also be destroyed. 
This effects the cure of the disease, but not always of the conse- 
quences. 

I have already observed, that this form of the disease is not capa- 
ble of being continued beyond a certain time in any constitution; 
and that in cases where it is violent, or lasted long, it is owing to 
the parts being very susceptible of such irritation, and readily retain- 
ing it. As we have no specific medicine for the gonorrhoea, it is for- 
tunate that time alone will effect a cure: it is therefore very reason- 
able to suppose, that every such inflammation ceases of itself; yet, 
although this appears to be nearly the truth, it is worthy of considera- 
tion, whether medicine can be of any service in this form of the dis- 
ease. I am inclined to believe it is very seldom of any kind of 
use, perhaps not once in ten cases; but even this would be of some 
consequence, if we could distinguish the cases Avhere it is of service, 
from those where it is not. Upon the idea that every gonorrhoea 
cures itself, I gave certain patients pills of bread, which were taken 
with great regularity. The patients always got well, but some of 
them, I believe, not so soon as they would have done, had the artifi- 
cial methods of cure been employed. 

The methods of cure hitherto recommended, and still followed by 
different people of the profession, are of two kinds. They consist 
either of internal remedies, or local applications; but in whichsoever 
of these two ways this disease is to be treated, we are always to pay 
more attention to the nature of the constitution, or to any attending 
disease in the parts themselves, or parts connected with them, than 
to the disease itself. 



CHAP. IV. OF GONORRHCEA. 77 

The nature of the constitution is principally to be learned from the 
local effects; for the local effects of this poison are so different in dif- 
ferent people, as to require great variety of treatment; but this has 
been too little attended to, every one endeavouring to attack the im- 
mediate symptoms as if he had a specific for a gonorrhoea. 

The first thing to be considered is, the nature of the inflammation, 
whether violent or mild, whether common or irritable; yet, even 
when this is ascertained, we have not in all cases the cure in our 
power; for I have already observed, that some people are very sus- 
ceptible of this irritation, who are, as it were, insensible to others; 
and, on the contrary, many are easily affected by common inflam- 
mation, who are insensible to this. These last are rather uncommon 
dispositions, and the cure being always easy they demand little at- 
tention. When the symptoms are violent, but of the common inflam- 
matory kind, which is to be collected from the attending circum- 
stances, particularly the extent of the inflammation not exceeding the 
specific distance, the local mode of cure may be either irritating or 
soothing. Irritating applications in the present case may be attend- 
ed with less danger than in the irritable inflammation,* and may alter 
the specific action; but to produce this effect it must be greater -than 
the irritation from the original injury. The parts will afterwards 
recover of themselves, as from any other common inflammation. 
After all, however, 1 believe the soothing plan is the best at the be- 
ginning. If the inflammation be great, and of the irritable kind, no 
violence is to be used in the cure, (for it will only increase the 
symptoms,) unless we know that the great degree of inflammation 
arises entirely from a susceptibility of this irritation, and that there 
is no general irritability in the constitution; which seldom can be 
ascertained. In cases where the symptoms run high, nothing should 
be done that may tend to stop the discharge, either by internal or 
external means, for nothing would be gained thereby; as we may 
stop the discharge, and not put an end to the inflammation. The 
constitution is to be altered, if possible, by remedies adapted to each 
disposition, with a view to alter the actions of the parts arising from 
such dispositions, and reduce the disease to its simple form. If the 
constitution can be altered, nothing is to be done but to allow the 
action to wear itself out. 

When the inflammation has considerably abated, and the disease 

* It is very difficult to give clear Ideas of distinctions in disease, when they 
are not marked by something permanent as to time, space, &c. I have used 
the term irritable inflammation, because I think this kind of inflammation takes 
place more in weak irritable habits than in others ; it appears to be guided by no 
law that 1 am acquainted with. It may be called an ill formed inflammation, as not 
going through the usual process to a natural termination, but continuing with 
little variation ; and if such inflammation were to take place in the cellular 
membrane, it would rather produce an ccdematous swelling, than such as arises 
from the extravasation of coagulable lymph, which takes place in what I would 
call the true inflammation. 



73 OF GONORRHOEA. CHAP. If. 

only remains in a mild form, its cure may be attempted either by 
internal remedies, or local applications. If a local cure be attempted, 
violence is still to be avoided; because it may bring back the irrita- 
tion. At this period gentle astringents may be applied with a pros- 
pect of success; or, if the disease has begun mildly, and there are no 
signs of an inflammatory disposition, either of the common kind, or 
the irritable, in order to get rid of the specific mode of action quick- 
ly, an irritating injection may be used, which will increase the symp- 
toms for a time, but when it is left off they will often abate, er 
wholly disappear. In such a state of parts, astringents may be used: 
for the only thing to be done is, to procure a cessation of the dis- 
charge, which is now the principal symptom. 

In those cases where the itching, pain, and other uncommon sen- 
sations are felt for some time before the discharge appears, I should 
be inclined to recommend the quieting or soothing plan instead of 
the irritating, with a view to bring on the discharge, as that effect is 
a step towards a resolution of the irritation; but how far it would 
really be the proper plan I cannot absolutely say, not having had 
experience enough in such cases. One thing, however, I think I 
may assert from reasoning, that to use astringents would be bad 
practice, as they would rather tend to prevent the discharge from 
taking place, which might prolong the inflammation and protract the 
cure. In cases of stricture, or in cases of diseased testicles, I be- 
lieve, astringents should not be used; for we find in either case, while 
the discharge lasts, both complaints are relieved; therefore, in such 
cases we should proceed with more caution than when all the parts 
are otherwise sound. If we had a specific for venereal gonorrhoea, 
it would still be a question, whether this specific could cure the irri- 
tation before the full action had taken place. 

It is not merely a conformity with the inference manifestly arising 
from the position, (that the disease, in whatever form it appears, arises 
from the same cause J which induces me to believe that it may be al- 
ways cured by the same means. An accurate examination of every 
authority, as well as my own practical observations, would lead 
to the conclusion, that the means which cures a chancre will destroy 
the venereal action of gonorrhoea, and that though the discharge may 
remain, yet it will not be of the virulent or contagious property which 
it possessed before such means were used. This subject is discussed 
more at large in " Morbid Poisons,"" where the opinions of Mr. 
Whateley and several others are noticed. 

For relieving the first urgent symptoms, however violent the in- 
flammation may be, as long as it maintains the specific distance, we 
have nothing to contend with but inflammation, which we shall al- 
ways know how to manage. If the disease spreads, we must be in- 
quisitive concerning all the peculiarities of the patient's constitution 
before we attempt any means of relief. 



SECT. II. OF GONORRHOEA^ 39 

SECTION I. 

Of the different Modes of Practice — Evacuants — Astringents. 

The internal remedies commonly recommended in a gonorrhoea, 
may be divided into evacuants and astringents. The evacuants are 
principally of the purgative or diuretic kind, and these not confined 
to any particular medicines; for every practitioner supposes that he 
is in possession of the best. Some use mercurial evacuants, while 
Others carefully avoid mercury in every form. The neutral salts have 
been given from the idea of their being cooling. Some of the pro- 
fession have kept principally to diuretics, perhaps with two views, as 
evacuants acting upon the urinary passages mechanically, to wash off 
the venereal matter, or as specifics for the latter purpose :"nitre has been 
given with this view; besides, it has been supposed to lessen inflam- 
mation; but its virtues in this way I very much doubt. Under these 
different modes of treatment the patients always get well, and the. 
cures are ascribed by each practitioner to his own method of treat- 
ment. 

To keep the body open in most cases, even when the patient is in 
other respects in health, must, no doubt, be proper; but what idea can 
we form of an irritation produced all along the intestinal canal, cur- 
ing a specific inflammation in the urethra? Yet there are cases where 
a brisk purge has been of service, and even in some has performed ;• 
cure. But I suspect that in such cases the disease had been contin- 
ued by habit only, and that this practice would not have succeeded 
in the beginning. A gentleman had a gonorrhoea, all the symptoms 
of which continued for two months, and by taking at once ten grains 
of calomel, which purged him most violently, he was almost imme- 
diately cured. The calomel could not have acted specifically, but 
by a kind of derivation, that is an irritation, produced in one part. 
cured one that subsisted in another; but even if it should be granted. 
that in some constitutions purges have the power of making the solids 
less susceptible of this irritation, it cannot be supposed they will have 
this effect in every case; in some constitutions they might debilitate, 
increase irritability, and of course increase the symptoms. These 
contrary effects must take place in different constitutions in which a 
medicine has no specific action. On the supposition of the cure 
being promoted by an evacuation from the blood, what service can 
purging out some of the blood in form of a secretion from one part do, 
to an inflammation of another part? On such a supposition, would 
not a sweat, or an increase of saliva by chewing tobacco, or stimula- 
ting the nose by snuff, all tend equally to cure a gonorrhoea? But 
humors having been considered as the universal cause of every dis- 
rate, especially those in which pus is formed or a discharge produced. 



SU OF GONORRHOEA. CHAP. I. 

and purging having been supposed to be the cure for humors, purga- 
tives were of course made use of in this disease; and as the patients 
have always been cured, the practice became generally established. 

Those who recommended mercury in this form of the disease, did 
it most probably from the opinion that this medicine was a specific 
for the venereal disease in all its forms. On this supposition we can 
see some reason for their practice, as it would be absorbed from the 
intestines, circulate through the inflammed vessels of the the urethra, 
and thereby destroy the venereal irritation. Here we can only sup- 
pose it to act by its specific virtue: but I doubt very much of mer- 
cury having any specific virtue in this species of the disease, for I find 
that it is as soon cured without mercury as with it; and where this 
medicine is only used as a purge, or purged off the next day, and 
therefore allowed to act merely upon the bowels, I cannot conceive 
that it could have any more effect upon the venereal inflammation in 
the urethra, than an irritation in the bowels arising from any other 
purgative. So little effect indeed has this medicine upon a gonorrhoea, 
that I have known a gonorrhoea take place while under a course of 
mercury sufficient for the cure of a chancre. Whether the gonorrhoea 
arose from the same infection that produced the chancre, I cannot 
say; nor can it be easily determined in such cases. Men have also 
been known to contract a gonorrhoea when loaded with mercury for 
the cure of a lues venerea; the gonorrhoea, nevertheless, has been as 
difficult of cure as in ordinary cases. 

A gentleman committed himself to my care on the 27th of June, 
for the cure of two chancres and a bubo. I dispersed the bubo, but, 
as he disliked the unction, I was obliged to substitute mercurius cal- 
cinatus daily, instead of it, giving two grains in the evening and one 
in the morning. About the middle of July his mouth became sore, 
and the mercury was left off; we began its use again in a week, and 
he appeared to be quite well of his venereal complaints. I, however, 
continued the use of mercury, keeping his mouth sore, and on the 16th 
of August, while in this state, he had a connexion with a woman, 
both on that and the following evening, and in five days after, a go- 
norrhoea appeared, and proved to be very violent. 

The same general observations may be made with regard* to the 
effects of diuretics, considered as evacuants. 

It is possible that specific medicines taken into the constitution, 
(if we had such,) and passing off by urine, might act upon the urethra 
in their passage through it. The balsams and turpentines pass off 
in this way, and become specifics for many irritations in the urinary 
passages; but how far medicines which have the power of affecting 
particular parts when sound, or when under diseases peculiar to those 
parts, have also the powers of affecting a specific irritation in these parts, 
I know not; but do not believe they have any considerable powers in 
this way. It is possible, however, that they may remove any attending 
irritation, although not the specific one. Diuretics have, nevertheless. 



SECT. II. OP GONORRHOEA. 81 

their advantages; for if they produce a greater quantity of water, they 
do good: but I believe this had better be effected by simple water, or 
water joined with such things as will encourage the patient to think a 
good deal, as tea, syrup of capillaire, orgeate, and the like. 

Astringents, although often given, yet have always been con- 
demned by those who have called themselves the judicious and regu- 
lar practitioners; because, according to them, there is something to be 
carried off, and if that is not carried off, a lues venerea is to be the 
consequence. This reasoning is not just, and therefore the question 
to be considered is, Do they, or do they not, assist us in the cure of 
the gonorrhoea? I believe they do not in any case lessen the venereal 
inflammation; but certainly they often lessen the discharge. As that 
effect, however, does not constitute a cure, it is not necessary to pro- 
duce it. 

I can conceive that a combination of astringents, especially the spe- 
cific astringents of those parts, as the balsams, with any other medi- 
cine which may be thought to be of service, may help to lessen the 
discharge in proportion as the inflammation abates; and this I have 
often seen, as will be explained more at length hereafter. 



SECTION II. 

Qf local Applications — Different kinds of Injections — Irritating — 
Sedative — Emollient — Astringent. 

Local applications may be either internal to the urethra, external 
to the penis, or both; all of which will in many cases be necessary. 
The internal, applied to the urethra, should seem the most likely to 
cure this species of disease, by coming immediately in contact with 
the diseased parts; for if they have any power of action, whatever 
that be, it must be in opposition to the venereal irritation. There- 
fore we might suppose, that most irritations that are not venereal, 
would tend to a cure; but certainly this is not universally the case. 
If, on the contrary, the applications are such as quiet irritation, they 
must also be of service. 

Local applications to the urethra may be either in a solid or fluid 
form, each of which has its advantages and disadvantages. A fluid is only 
a temporary application, and that of very short duration, and is similar 
to the washing of a sore, which is, I believe, in most cases unnecessary; 
for I imagine that matter, from any sore whatever, is always such as 
cannot stimulate that sore into any action: it can be of no consequence, 
therefore, whether the matter is allowed to lie upon it, or not; but it 
being removed, the medicines are allowed to come in contact with 

i 



82 OF GONORRHEA. CHAP. IV. 

the inflamed surface. I apprehend, it is only in (his way that the 
removal of it can be of service. The solid applications may remain 
a long time, and are similar to the dressings in the case of a wound. 
When the parts are not so much inflamed as to prevent the use of 
ihem, they would appear to have an advantage over the fluid appli- 
cations by continuance; but they in general irritate immediately, in 
consequence of their solidity alone. These applications must be in 
the form of a bougie; but I should be inclined to suppose that the less 
use that is made of bougies, when these parts are in an inflamed 
state, the better; although I cannot say that I ever saw any bad ef- 
fects from them in any case, when' applied with caution. 

Fluid applications to the inside of the urethra are commonly called 
injections, and, like the internal remedies, are without number; every 
practitioner thinking, or wishing to make the world think, that his 
own is the best. But, as every venereal inflammation is frequently 
removed under the use of injections of various kinds, (which were ob- 
served with respect to internal medicines,) have we not here a strong 
corroborating circumstance in favour of an opinion, that every such 
complaint will in time cure itself? I think, however, it appears from 
practice, that an injection will often have almost an immediate effect 
upon the symptoms, and that, therefore, they must have some powers; 
and yet the kind of injection which would have the greatest specific 
powers, I believe, is not yet known: if an injection has no specific 
powers, it must be very uncertain in its effects, and can only be of ser- 
vice as far as it may be adapted to a peculiarity of constitution or 
parts. As injections are only temporary applications, it becomes 
necessary to use them often, especially in cases where they are found 
to be of service; they should therefore be applied as often as conve- 
nient, perhaps every hour, or even oftener; but this must be regulated 
in some measure by the kind of injection; for if it be irritating, it 
will not be proper to use it so often, as it may be productive of bad 
consequences. 

Many injections immediately, or at least soon after the applica- 
tion, remove the symptoms, and prevent the formation of matter, 
which has given rise to the notion of their shutting up the disease, 
and driving it into the constitution; but this supposed mode of pro- 
ducing a constitutional complaint, is the reverse of what really hap- 
pens; for I have already endeavoured to prove, that matter is the. 
only substance in which the poison is contained, and that the forma- 
tion of the poison is inseparable from the formation of matter; there- 
fore if we can prevent the one, the other cannot take place, and of 
< ourse there can be no room for absorption: so that there can nei- 
ther be any power of infecting the constitution in the same person, 
nor of communicating the infection to others.* 

When the discharge is an effect of present inflammation, it may 

* Vide page 28, what was said in the method of contracting the lues venerea 



3ECT. II. OF GONORRHOEA. 






be stopped by injections, though the inflammation still continue 10 
some degree, and may afterwards be removed without the discharge 
ever re-appearing. But I believe that by this practice little is gain- 
ed; for the effect of the inflammation is not the disease which we 
wish to remove. However, we find that the same method which 
stops the discharge, also removes the inflammation, although not al- 
ways, and only I believe when the inflammation is slight. 

I shall divide injections, according to their particular effects upon 
the urethra, into four kinds, the irritating, sedative, emollient, and 
astringent. The specific, I believe, is not yet discovered, although 
a mercurial injection, in some form or other, is by most people sup- 
posed to be possessed of such a power, and of course this mineral 
makes part of manv of the injections now in use. 

Irritating injections, of whatever kind, 1 suspect, in tins disease 
act upon the same principle, that is, by producing an irritation ol 
another kind, which ought to be greater than the venereal, by which 
means the venereal is destroyed and lost, and the discus.' is cur- 
although the pain and discharge may still be kept up by the injec- 
tion. Those effects, however, will soon go off when the injection is 
laid aside, because thev arise only from its irritating qualities. In 
this wav bougies, as well as many injections, may be supposed to 
perforin a cure; and although they increase the symptoms or the 
time they never can increase the disease itself, any more than the 
same' injection, which would produce the same symptoms, it applied 
to the urethra of a sound man, can communicate the disease. Most 
of the irritating injections have an astringent effect, and prove simplj 
astringents when mild; their irritating quality depending chiefly 
upon their strength. . 

As irritating injections do not agree with all inflammations arising 
from the venereal poison,' it may be asked, In what cases are the 
irritating injections to be used with advantage ? This I have not been 
able to determine absolutely; but I think irritating injections shou d 
never be used where there is already much inflammation, especially 
in constitutions which cannot bear a great deal of irritation, as a pre- 
vious knowledge of the- disease in the same person sometimes eachc, 
us; nor should they be used where the irritation has spread beyond 
the specific distance; nor where the testicles are tender; nor where 
upon the discharge ceasing quickly, they have become sore; nor 
where the perinafum is very susceptible ol inflammation, and esfte- 
cially if it formerly has suppurated; nor where there is a tendency 
in the bladder to irritation, which is known from the patient Inv. mg 
had for some time a frequency in making water. In such cases 1 
have not succeeded with them; they not only do no good, bu, 
often do harm; for I have seen them make the inflammation spread 

• For 1 have already remaned, that the inflammation varies according to Lite 
constitution. 



84 OF GONORRHOEA. CHAP. IV. 

further in the urethra;* and I think I have had reason to suspect, 
that they have been the cause of abscesses in perinaeo. But in cases 
that are mild, and in constitutions that are not irritable, injections 
often succeed, and remove the disease almost immediately. The 
practice, however, ought to be attempted with caution, and not, per- 
haps, till milder methods have failed. Two grains of corrosive sub- 
limate, dissolved in eight ounces of distilled water, are nearly as 
good an injection as any of the kind. But an injection of only half 
this strength may be used, where it is not intended to attempt a cure 
so quickly. If, however, the injection, even in that proportion, gives 
considerable pain in its application, or if it occasions a great increase 
of pain in making water, it should be diluted. 

Sedative injections will always be of service in cases where the 
inflammation is considerable, not by lessening the disease itself, but 
by lessening the diseased action, which always allows the natural ac- 
tions of the part more readily to take place. They are likewise very 
useful in relieving the painful feelings of the patient. Perhaps the 
best sedative we have is opium, as well when given by the mouth or 
anus, as when applied to the part affected in the form of an injection. 
But even opium will not agree, or act as a sedative in all constitutions, 
or parts. On the contrary, it has often opposite effects, producing 
great irritability. Lead may be reckoned a sedative, so far as it 
abates inflammation, while at the same time it may act as a gentle 
astringent. Fourteen grains of saccharum saturni, in eight ounces of 
distilled water, make a good sedative astringent injection. 

The drinking freely of diluting liquors may, perhaps, be considered 
as having a sedative effect, as it in part removes some of the causes 
of irritation, rendering the urine less stimulating, either to the blad- 
der, when the irritation is there, or to the urethra in its passage 
through it; and it is possible, that diluting may lessen the suscepti- 
bility of irritation. The vegetable mucilages of certain seeds and 
plants, and the emollient gums, are recommended; but I suspect that 
this practice is founded on a mechanical notion, and that none of 
them are of much service. I believe, the advantage arises chiefly 
from the quantity of water that is drunk; and that if the water be 
joined with any thing, spirits excepted, that can induce the patient 
to drink freely, the purpose is fully answered. I have, however, been 
informed by some patients, that they have thought, that, when the li- 
quids they drank have been impregnated with mucilaginous sub- 
stances, they have had less uneasiness in making water. 

Emollienf injections are the properest applications where the in- 
flammation is very great. They ore most probably useful by first 
simply washing away the matter, and then leaving a soft application 
to the part; in which way I can conceive them to be of singular ser- 



* It is, however, to be remarked, that this symptom is not always to be 
bated lo ilie ipjeCtion * f«r it often happens when none lias been used. 



attri- 



SECT. II. OP GONORRHOEA. 85 

vice, by lessening the irritating effects of the urine. Indeed prac- 
tice proves this; for we often find that a solution of gum arabic, milk 
and water, or sweet oil, will lessen the pain and odier symptoms, 
when the more active injections have done nothing, or have seemed 
to have done harm. 

It very often happens, that the irritation is so great at the orifice of 
the urethra, that the point of the syringe cannot be suffered to enter. 
When this is the case, nothing should be done in the way of injec- 
tion till the inflammation abate. Emollients may likewise be used 
externally in form of fomentation. 

The astringent injections can only act by lessening the discharge. 
They can have no specific effect upon the inflammation; but, as they 
must affect the actions of the living powers, it is possible they may 
alter the venereal disposition. They should only be used towards 
the latter end of the disease, when it has become mild, and the parts 
begin to itch. But this should be according to circumstances, and, 
if the disease begins mildly, they may be used at the very beginning; 
for, by gradually lessening the discharge, without increasing the in- 
flammation, we complete the cure, and prevent a continuation of the 
discharge, called a gleet. Injections of this kind very probably stimu- 
late in such a way as to make the vessels of the part contract, and 
probably hinder the act of secretion. We can hardly suppose that 
they act chemically by coagulating the juices. They will have an 
irritating quality if used strong; which in some measure destroys 
their astringency, or rather makes the parts act contrary to what they 
would do from the application of a simple astringent. Thus they 
often increase the discharge instead of lessening it; by which means 
the disease also may be cured in the same way as by irritating injec- 
tions, that is, by altering the disposition of the inflammation. When 
more mild, they often stop the discharge, without, however, in all 
cases hastening the cure; for the inflammation may still continue 
even longer than it otherwise would have done, if the tendency to se- 
cretion had not been stopped. I have already observed, that a sur- 
face that discharges has assumed the complete action of the disease, 
which is one step towards a cure or termination. However, it some- 
times happens, that an astringent injection will cure a slight irrita- 
tion in a very few days. My experience has not taught me that one 
astringent is much better than another. 

The astringent gums, as dragon's blood, the balsams, and the tur- 
pentines, dissolved in water; the juices of many vegetables, as oak- 
bark, Peruvian-bark, tormentil-root, and perhaps all the metallic salts, 
as green, blue, and white vitriols; the salts of mercury, and also 
alum; probably all act much in the same way; although we may as- 
sert, that they do not always act equally well in every gonorrhoea; for 
on our changing the injection, we sometimes succeed, after several 
others have been tried in vain. 

The external applications are generally poultices and fomcnla- 



g(J OF GONORRHCEA. CHAP. IV. 

tions; but they can be of little service, except when the external 
parts such as the prepuce, glans, and orifice of the urethra, are in 
some degree inflamed; the last, indeed, is almost always more or less 

When the glands of the urethra are so much swelled as to be 
felt externally, the application of the mercurial ointment to the part 
may be proper; but most probably this will be of more service alter 
the inflammation has subsided. Indeed, mercurial ointment is olten 
applied to all the external surfaces of those parts, when in a state oi 
inflammation, with an emollient poultice over it. I am not perlectly 
satisfied of the utility of this practice. 

On this invaluable series of practical remarks I shall only make 
one observation. 

In all cases of gonorrhoea, if not attended with any unusual symp- 
toms, I have found the injection of corrosive sublimate the most con- 
venient and efficacious. The remedy in this form was, I believe, 
new when Mr. Hunter wrote, which may account for his very cau- 
tious manner of speaking of it. Mr. Whateley has very much sim- 
plified the practice, by proposing the solutions in different degrees of 
strength, or diluted according to the feelings of the patient, or irrita- 
bility of his constitution. 

On a former occasion, I mentioned an intention of renewing the 
question, whether venereal gonorrhoea will cure itself, or, as Mr. 
Hunter with more accuracy expresses it, wear itself out. The pre- 
sent offers a passage for reviving the inquiry. " Irritating injec- 
tions, I suspect," says Mr. Hunter, " act by producing an irritation 
of another kind, which ought to be greater than the venereal." No- 
thing can be more reasonable; but does not the inference follow, 
that after a time the venereal inflammation by degrees becomes so 
slight, that its existence can only be known by the action it retains 
of secreting a fluid in a very inconsiderable quantity? In this state, 
may not a very trifling irritation, one which may almost pass unno- 
ticed by the patient, be sufficient to supersede the venereal action; 
and thus, may not the disease be cured in the usual way, whilst it ap- 
pears to have ceased spontaneously? The analogy holds good in the 
treatment of the constitution, as we shall see in the next chapter. 



CHAP - V \ OF GONORRIICEA. 87 

CHAP. V. 

Of the Cure of Gonorrhoea in Women. 

In women the cure of the gonorrhoea is nearly the same as in men; 
but the disease itself is milder, and the secondary symptoms less nu- 
merous in women. This arises from there not being so many parts 
to be affected, and from those parts not being either of so great ex- 
tent, or so liable to inflammation. Hence the cure becomes more 
simple. 

When the disease is in the vagina only, it is easily cured. Injec- 
tions are the best means that can be used, and, after the use of them, 
it may be proper to anoint the parts, as far up as possible, with mer- 
curial ointment,* and also to wash the external parts often with the 
injection. 

If the inflammation has attacked the urethra, injections there can- 
not be so conveniently used, as it is almost impossible for the patient 
to throw an injection into that canal. 

The injections, recommended in the cure of men, are equally ser- 
viceable here; but they may be made doubly strong, as the parts of 
women are not nearly so irritable as the common seat of this disease 
in men. 

If what I have said of the disease in women be just, we must see 
that it will be a difficult thing to say, with any degree of certainty, 
when the patient is well; because, whenever the symptoms have 
ceased, the surgeon and the patient will naturally suppose the cure 
to be complete; but a new trial of those parts may prove the con- 
trary; or in cases where the disease has never affected the urethra, 
but only the vagina, and still more where no symptoms have ever 
been observed, it will be more difficult to fix the date of the cure; but 
general experience must direct the practitioner. 

When the inflammation runs along the ducts of the glands, whe- 
ther those of the mouth of the vagina, or urethra, or affects the glands 
themselves, the same method is to be followed; in particular, the 
mercurial ointment is to be freely applied to the parts. If the in- 
flammation on the mouths of the ducts is so great as to shut them 
up, the duct and glands will suppurate, and form abscesses: in such 
cases it will be necessary to open them, or enlarge the opening al- 
ready formed, and dress the abscess as a chancre or bubo. 

In the case of a simple running, the constitutional treatment will 
be taken notice of hereafter; but if any suppuration follow, the con- 

* How far mercurial ointment assists in the cure, I have not been able to de- 
termine ; the use of it arises more from a kind of practical analogy than real ex- 
perience in such cases 



88 OF GONORRHOEA. CHAP. VI. 

stitution is to be treated as in chancres or buboes; for most probably 
absorption will take place, and its effects must be guarded against. 

In either sex, where a discharge from a suspicious source cannot 
be made to subside, though all inflammatory symptoms may have 
ceased, I am inclined to believe that a salivation would destroy the 
venereal or contagious property of the discharge, nor would I pro- 
nounce any gleet free from danger without such a precaution. 



CHAP. VI 

Of the Treatment of the Constitution in the Cure of the Gonorrhma. 

In the cure of the gonorrhoea, the constitution is, in some cases, 
to be as much attended to as the parts affected, if not more; but in 
general this is not necessary. The knowledge of the constitution is 
to be obtained, in a great measure, from the local symptoms; and as 
far as the constitutional treatment can be made similar to the local, 
they should correspond. 

We find in many strong plethoric constitutions, where both the 
powers and actions are great, that the symptoms are violent. These 
constitutions have generally a strong tendency to fever of the inflam- 
matory kind; and probably the most distinguishing mark of such a 
constitution is that of the symptoms not extending beyond the speci- 
fic distance. Many medicines, which might be of service in another 
constitution, will often prove hurtful here, in so much as to increase 
the very symptoms which they were meant to relieve. I have seen 
even opiate clysters, though they relieved at first, yet in the end pro- 
duce or increase fever, and by that means increase all the symptoms. 
I have seen the balsam capivi, given such cases, increase the inflam- 
matory symptoms, probably by stopping the discharge in part, which 
appears to be salutary. The treatment of such a constitution, when 
affected with this disease, consists chiefly in evacuations, the best of 
which are bleeding and gentle purging. To live sparingly, and above 
all to use little exercise, is necessary; for although such a treatment 
does not lessen the venereal irritation, yet it lessens the violence of 
the inflammation, and allows the parts to relieve themselves. In this 
kind of constitution, therefore, the disease is in the end soonest cured, 
as there is not a tendency to a continued inflammation. 

In the weak and irritable constitution, the symptoms are frequently 
very violent, arising from great action in the parts, and often extend 



$HAP. VI. OF GONORRHOEA. 89 

beyond the specific distance; the inflammation running along the ure- 
thra, and even affecting the bladder. Instead of evacuations, which 
would rather aggravate the symptoms than relieve them, the consti- 
tution should be strengthened, and thus it will be less susceptible of 
irritation in general. 

I have seen patients, whose constitutions were such, that they were 
never sure of twenty-four hours health, where the inflammation has 
been both considerable and extensive. I have seen evacuations tried, 
and the symptoms increased; but as soon as the bark was given 
freely, they have become almost immediately mild; and without 
using any other medicine, the patients have soon recovered. The 
medicine here acted upon the constitution; destroyed the irritability; 
gave the parts a true and healthy sense of the venereal irritation, and 
brought the inflammation to that state, in which it ought to be in a 
healthy subject; whereby the constitution was enabled to cure itself. 
So capricious sometimes is this form of the disease in its cure, that 
the accession of an accidental fever has stopped the discharge; the 
pain in making water has ceased, and the gonorrhoea has finally ter- 
minated with the fever. In others I have seen all the symptoms of 
the gonorrhoea cease on the accession of a fever, and return when 
the fever has been subdued. In some I have seen a gonorrhoea begin 
mildly, but a severe fever coming on, and continuing for several days, 
has greatly increased the symptoms; and on the fever going off, the 
gonorrhoea has also gone off. Although a fever does not always cure 
a gonorrhoea, yet as it possibly may, nothing should be done while 
the fever lasts; and if it continues after the fever is gone, it is then 
to be treated according to the symptoms. 

Unfortunately there are cases where no known method lessens 
the symptoms; evacuations have produced no abatement; the strength- 
ening plan has been as unsuccessful; sedatives and emollients have 
procured no relief; and time alone has performed the cure. In 
such cases, the soothing plan, I believe, is the best, till we know 
more of the disease. Astringents should not be used, their action 
upon the inflamed parts being uncertain; for they often do not les- 
sen the inflammation or the pain, although they may, perhaps, les- 
sen the discharge. The turpentines, especially the balsam capivi, 
and Canada balsam, lessen the disposition of the parts to form matter 
which effect has always a salutary appearance; but as they have not 
at the same time the power of lessening the inflammation, they can 
be of little service. . 

Besides the various effects arising from the difference of con- 
stitution in the gonorrhoea, we find that it is considerably affected by 
the patient's way of life, during the inflammatory state, and also by 
other diseases attacking the constitution at the same time, but this 
is common to all other diseases; for whenever we have a local dis- 
ease fin which light I have considered a gonorrhoea,) it is always af- 
fected by whatever affects the constitution. Most, things that hurry, 

M 



90 OF GONORRHOEA. CHAP. VI. 



or 



„ increase the circulation, aggravate the symptoms; such as violent 
exercise; drinking too much of strong liquors; eating strong indi- 
gestible food, some kinds of which act specifically on these parts, 
thereby increasing the symptoms more than by simply heating the 
body, such as peppers, spices, and spirits. 

From what has been said in general, it must appear that a gonor- 
rhoea is to be cured in the same way as every other inflammation; 
and it must also appear, that all the methods used are only to be con- 
sidered as correctors of irritation in general, and of disordered circu- 
lation. In cases that have begun mildly, where the inflammation 
has been but slight, or in those cases where the violent symptoms, 
above taken notice of, have subsided, such medicines as have a ten- 
dency to lessen the discharge may be given along with the local re- 
medies before mentioned. The turpentines, I believe, are the most 
efficacious. Cantharides, the salts of some metals, such as of cop- 
per, and lead, and also some earths, as alum, are strongly recom- 
mended as astringents when given internally. 

Whatever methods are used for the cure, locally or constitutionally, 
it is always necessary to have in view the possibility of some of the 
matter being absorbed, and afterwards appearing in the form of a lues 
venerea; to prevent which I should be inclined to give small doses 
of mercury internally. At what time this mercurial course should 
begin, is not easily ascertained; but if the observation be just, that a 
disposition once formed is not to be cured by mercury, but that mer- 
cury has the power of preventing a disposition from forming, as was 
formerly explained, we should begin early, and continue it to the end 
of the disease, till the formation of venereal matter ceases, and even 
for some time after. The mercurial ointment may be used where 
mercury disagrees with the stomach and intestines. 

This practice appears to be more necessary if the discharge has 
continued a considerable time, and especially if the treatment has 
been simply by evacuants; for, in the former case, there is a greater 
time for absorption, and in the latter we may suppose a greater call 
for it, such medicines having no effect in carrying off the virus. 

To prevent a lues venerea being produced from absorption, a 
grain of mercurius calcinatus taken every night, or one at night and 
another in the morning, may be sufficient; but should be continued 
in proportion to the duration of the disease. 

The success of this practice, in any particular case, can never be 
ascertained, because it is (impossible to say, when matter has been 
absorbed, except in cases of buboes; and where it is not known to be 
absorbed, it is impossible to say that there would have been a lues 
venerea if mercury had not been given, as very few are infected from 
a gonorrhoea, although they have taken no mercury. It is, however, 
safest to give mercury, as we may reasonably suppose it will often 
prevent a lues venerea, as it does when given during the cure of a 



CHAP. VII. OF GONORRHOEA. 91 

chancre or bubo, where we know, from experience, that without it, 
the lues venerea would certainly take place. 



It will be necessary first to anticipate Mr. H.'s doctrine of the cure 
ef chancre by mercury, which, whether admitted or not, is no way 
necessary to our present purpose;* our only business being to pro e, 
that if the doctrine is right in that instance, gonorrhoea is so often 
cured by a similar process, without mercury, as to render it at least 
doubtful whether it is ever cured by the mere spontaneous uninter- 
rupted powers of the constitution. 

Mr. Hunter, we shall find, considers the cure of other symptoms 
of the venereal disease by mercury, as the consequence of a higher 
irritation being excited than the venereal. In the same way he con- 
ceives that gonorrhoea may be cured by the application of local sti- 
muli, which may excite a higher degree of irritation than the vene- 
real. (See part II. chap. IV. section II.) In the present passage 
he shows us, that certain constitutional irritations have been sufficient 
to supersede the gonorrhoeal action. " A fever coming on," says he, 
" has stopped the discharge; the pain in making water has ceased, and 
the gonorrhoea has finally terminated with the fever," &c. — Now, 
when we consider the frequency of little ephemeral fevers in some 
constitutions, without any apparent cause, particularly in females; 
when we consider the various accidental causes of short, though 
sometimes severe, fevers in men; can we wonder if they are often 
sufficient to supersede the gonorrhoeal action, especially when the 
disease has become chronic? When we reflect on this, and on the un- 
certainty of the real cause of gonorrhoea,- it does not appear to me 
that we are authorized in saying, that the venereal gonorrhoea will 
cease, without the excitement of some new irritation, local or con • 
stitutional, by which the former is superseded. 



CHAP. VII. 

Of the Treatment of occasional Symptoms of the Gononhaa. 

As the following symptoms are only occasional consequences of a 
venereal gonorrhoea, being the effects of an irritation on the urethra, 
and therefore not venereal, they are to be treated in the same man- 
ner as if they had arisen from any other cause. 

* That must of course be considered in its order. 



<)g OF GONORRHOEA. CHAP. VII. 

SECTION I. 

Of the Bleeding from the Urethra. 

It has been already observed, that when the inflammation is vio- 
lent, or spreads along the urethra, there is frequently a discharge of 
blood from the vessels of that part. In such bleeding, the balsam 
capivi, given internally, has been of service; and it may be supposed 
that all the turpentines will be equally useful. I have not found any 
good effects from astringent injections; and, in some cases, have sus- 
pected that they have been the cause of this complaint. They al- 
ways go off in the usual time of the cure of the gonorrhoea. 



SECTION II. 

Of preventing painful Erections. 

Opium, given internally, appears to have great effects in prevent- 
ing painful erections in many cases. Twenty drops of tinctura the- 
baica, taken at bed time, has procured ease for a whole night. The 
cicuta likewise seems to have some powers in this way. 



SECTION III. 

Of the Treatment of the Chordee. 

In the beginning of this complaint, bleeding from the arm is often 
of service; but it is more immediately useful to take away blood 
from the part itself by leeches; for we often find by a vessel giving way 
in the urethra, and a considerable haemorrhage ensuing, that the pa- 
tient is greatly relieved. Relief will often be obtained by exposing 
the penis to the steam of hot water. Poultices likewise have benefi- 
cial effects; and both fomentations and poultices will often be assist- 
ed in removing inflammation by the addition of camphor. Opium, 
given internally, is of singular service; and, if it be joined with cam- 
phor, the effect will be still greater; but opium in such cases acts 
rather by lessening the pain than by removing the inflammation, 



SECT. IV. OF GONORRHOEA. 93 

though, by preventing erections, it miy be said to obviate, the imme- 
diate cause of the complaint. 

When the chordee continues after all other symptoms are gone, 
little or nothing, in the way of evacuation, seems to be necessary, the 
inflammation being subdued, and a consequence of it only remain- 
ing, which will cease gradually by the absorption of the extravasated 
coagulable lymph. Therefore bleeding, in this case, can be of no 
use. Mercurial ointment applied to the parts will promote the ab- 
sorption of the extravasated coagulable lymph; for experience has 
shown, that mercury has considerable powers in exciting absorption. 
The friction itself also will be of use. In one case considerable be- 
nefit seemed to result from giving the cicuta, after the common me- 
thods of cure had been tried. Electricity may be of service. This 
symptom is indeed often longer in going off than either the running 
or pain; but no bad consequences arise from it. Its declension is 
gradual and uniform, as happens in most consequences of inflamma- 
tion. 

In relieving the chordee, or the remains of it, which appear to 
arise from spasm, I have known the bark of great service. Eva- 
cuations, whether from the part, or from the constitution, generally 
do harm. 



SECTION IV. 

Of the Treatment of the Suppuration of the Glands of the Urethra. 

Suppurations in the glands of the urethra are to be treated as 
chancres. Therefore, mercury ought to be given, as will be ex- 
plained hereafter. 

Should a suppuration take place in Cowper's glands, it demands 
more attention. The abscess must be opened freely, and early, as 
the matter, if confined, may make its way either into the scrotum or 
urethra, whence would arise bad consequences. Here also mercury 
must be given, and perhaps as freely as in a bubo. In short, the 
treatment should be the same as in a venereal ulcer ; and in this 
respect it Avill differ from the treatment of those abscesses which 
arise in consequence of stricture 



94 OF GONORRHOEA. CHAr. VII. 

SECTION V. 

Of the Treatment of the Affection of tlie Bladder from Gonorrhoea. 

When the disease extends as far as the bladder, it produces a 
most troublesome complaint, from which, however, bad consequences 
seldom arise. But I suspect that it sometimes has laid the ground- 
work of future irritation in that part, which has proved very trouble- 
some, and even dangerous. _ „,.,,, c 

Opiate clysters, if nothing in the constitution forbid the use of 
them, procure considerable temporary relief. The warm bath is of 
service, although not always; and bleeding freely, if the patient is of 
a full habit, often does good. Leeches, also, applied to the pennaeum, 
have good effects; but in many constitutions, bleeding will rather do 
harm; and we should be cautious in making use of this evacuation, 
for it has been already observed, that many of these cases are rather 
from sympathy than inflammation. As this affection of the bladder 
often continues for a considerable time, producing other sympathies 
in the neighbouring parts, and is not in the least mitigated by the 
methods commonly used, I would recommend the following trials to 
be made use of in such cases. An opiate plaster to be applied to the 
pubes, or the small of the back, where the nerves of the bladder take 
their origin; a small blister on the perinaeum, which is of service in 
irritations of the bladder arising from other causes. 

In all cases of doubt concerning bleeding, it is of the first import- 
ance to learn the constitution of the patient, as well as his general 
habits. Whether he is subject to plethoric diseases, or to haemorr- 
hages which have not appeared for some time ? Whether he was in 
better health than ordinary before the violent symptoms occurred? 
We must never trust to appearances on these occasions; oftentimes 
those whose countenance is the most sanguineous being the most 
irritable, and bearing a free use of the lancet the least. 



SECTION VI. 

Of the Treatment of tlie Swelled Testicle. 

When the testicle sympathizes either with the urethra or bladder, 
and is inflamed, rest is the best remedy. The horizontal position oi' 
the body is the easiest, as such a position is the best for a free circu- 



SECT. VI. OF GONORRHOEA. 95 

lation. If the patient cannot submit to an horizontal position, it is 
absolutely necessary to have the testicle well suspended. Indeed the 
patient will be happy in having recourse to that expedient as soon as 
he is acquainted with the ease which it affords. 

In this complaint, perhaps, no particular method of cure can be 
laid down. It is to be treated as inflammation in general, by bleeding 
and purging, if the constitution requires them, and by fomentation 
and poultices. Bleeding with leeches has often been of service. 
This we cannot well account for, as the vessels of the scrotum have 
but little connection with those of the testicle. 

As I do not look upon the swelling of the testicle to be venereal, 
mercurials, in my opinion, can be of no service in these cases while 
the inflammation continues, but they are useful when that is gone, 
and the induration only remains. 

Vomits have been recommended in such cases, and are sometimes 
of service. I have known a vomit remove the swelling almost in- 
stantaneously. The effects of the vomit most probably arise from 
the sympathy between the stomach and the testicle. Opiates are of 
service, as they are in most irritations of those parts. When such 
swellings suppurate, which they seldom do, they require only to be 
treated as common suppurations; and mercury need not be given. 

In the history of this disease I observed, and indeed it has been 
observed by most writers, that when a swelling comes upon the tes- 
ticle, in consequence of a gonorrhoea, the running ceases; or when 
the running ceases, the testicle swells; but which is the cause, or 
which is the effect, has not yet been ascertained. It has been also 
observed, that when the running returns, the testicle then shows the 
first symptoms of recovery; so that the testicle having lost its sympa- 
thizing action, the action is restored to the urethra. And here also 
it has not yet been ascertained, which is the cause, or which is the 
effect; but from a supposition that the cessation of the discharge in the 
urethra is the cause of the swelling, it has been attributed to the 
mode of treatment of that irritation, and by some to injections. 

It has been advised by many, and attempted by some, to procure a 
return of the running; but tln/methods used have hardly been found- 
ed upon any sound principle. Mr. Bromfield appears to have been 
the first who recommended a treatment suitable to this theory, which 
was to irritate the urethra to suppuration again, by introducing 
bougies. 1 have not seen that benefit that could have been wished, 
or that (he first idea might induce us to expect, from this practice. 
Some have gone further, by recommending the introduction of vene- 
rea! matter into the urethra; but this appears to be only conceit, and 
is founded upon a supposition that such swellings arise only from 
venereal irritations. But I have already observed, that they are pro- 
duced by other causes. 

It is generally a long time before the swelling of the testicle en- 
tirely subsides, although it does so more quickly at first than swellings 



90 OF GONORRHOEA. CHAP. VII. 

of this part arising from other causes. Before it becomes less, it 
generally becomes softer, commonly on the anterior surface; and, by 
degrees, the whole becomes perhaps softer than natural, and then it 
diminishes. It is still much longer (sometimes even years) belore 
the epididymis returns to its natural state; sometimes it is never re- 
duced to its natural size and softness. However, this is of no great 
consequence, as no inconvenience results from a continuance of the 
hardness simply; though sometimes, perhaps, such testicles are ren- 
dered totallv useless. I never had an opportunity of examining the 
testicle of one that was known to have this complaint; but have ex- 
amined testicles where the epididymis has had the same external feel, 
and where the canal of the vas deferens has been obliterated. But 
this, I suspect too, seldom happens, for there are people who have 
both testicles swelled, and, notwithstanding, discharge their semen as 
before. 

It is in this stage of the complaint that resolvents may be of ser- 
vice, such as mercurial friction joined with camphor. Likewise, 
we may usefully apply fumigations with aromatic herbs, in order to 
stimulate the absorbents to take up the superfluous matter. Electri- 
city has been in some cases of singular service. 



There cannot be a stronger proof than this chapter affords of the 
advantage medicine, in common with all other arts, derives from 
close reasoning, drawn from facts which are obvious to the senses. 

If the swelling of the testicle arose from a translation of matter 
from the urethra to the testicle, we should invariably find, that, as the 
latter subsided, the former would return. But this is by no means 
the case; for, when the inflammation of the testicle is very violent, 
and continues long, it often happens that the discharge from the 
urethra will not return when that swelling and inflammation cease. 

During the inflammatory stage of gonorrhoea virulenta, all the 
parts connected with the urethra become highly irritable; and a very 
slight cause, the mere friction of the scrotum under violent exercise, 
may be sufficient to excite inflammation in the testicles. If that in- 
flammation is very violent, it will so occupy the constitution by uni- 
versal sympathy, (see Introduction,) as to spend all other violent ac- 
tions; and if this continues long, the inflammation may not return to 
the urethra on its cessation in the testicle. 



SECT. VII. OF GONORRHOEA. 97 

SECTION VII. 

Of the Decline and Termination of the Symptoms of Gonorrhoea. 

The decline of the disease is generally known by an abatement of 
some or all of the above-mentioned symptoms. The pain in the 
part becomes less, or terminates in an itching similar to what is felt 
in the beginning of many gonorrhoeas, and at last entirely goes off. 
The sense of weariness about the loins, hips, testicles, and scrotum, 
is no longer felt; and the transparent cherry-like appearance of the 
glans penis gradually disappears. These are the most certain signs 
of an abatement of the disease. 

The running becomes less; or, if it does not diminish, becomes 
first whiter, then of a paler colour, and gradually acquires a more 
slimy and ropy consistence, which has always been considered as the 
most certain sign of an approaching cure. When the running be- 
comes more slimy, it is then changed from matter to the natural fluid 
which lubricates the passage, and also to that fluid which appears to 
be preparatory to coition; but it is often very inconstant in its ap- 
pearances, arising frequently from different modes of living, exercise, 
or other causes. 

It often happens that all the symptoms shall totally disappear, and 
the patients shall think themselves cured; and yet the same symp- 
toms shall come upon them anew, commonly indeed milder than at 
first, though in some cases as violent, or even more violent; and this 
takes place sometimes at a considerable distance of time. I have 
known the symptoms return a month after every appearance of the dis- 
ease has been removed. However, in such cases, they seldom last 
long. How far this second attack is to be looked upon as truly ve- 
nereal, has not as yet been ascertained. Nothing can prove it abso- 
lutely to be venereal but the circumstance of having given it to a 
sound person. What may be the case with those in whom it has re- 
turned soon after the going off of the symptoms, I will not pretend to 
say; but I should very much suspect that, where the patient has con- 
tinued well for a month, a return cannot be venereal. This is only 
conjecture; and if we were to reason upon it, we might easily rea- 
son ourselves into a belief of its being venereal; for if the parts can 
fall back again into one mode of action, that of inflammation and 
suppuration, there can be no reason why they should not fall back 
again into the specific mode of action. However, as the common 
effect of irritation is suppuration, and as the specific suppuration re- 
quires a peculiar irritation, it is easier to conceive that the parts 
may fall into the common mode of action, than into both. It is pos- 
sible, however, that in such cases, the venereal action may be only 



98 OF GONORRHOEA. CHAP- VIII. 

suspended, similar to what happens between the contamination and 
complete appearance of the disease. 

In women, returns of the symptoms are more frequent than in 
men, particularly of the discharge; which, being similar to thefluor 
albus, and frequently taken for that disease, gives less suspicion, al- 
though they are perhaps equally virulent as those in men. 

The distinction between a gonorrhoea and a gleet is not yet ascer- 
tained; for the inflammation subsiding, the pain going off, and the 
matter altering, are no proofs that the poison is destroyed. It is no 
more necessary that there should be a continuance of the inflamma- 
tion to produce the specific poison, than there should be a continu- 
ance of the inflammation to produce the gleet, as will appear evident 
from two cases before related.* 

The first of these cases shows that the inflammation is not neces- 
sary to the existence of the venereal poison; and, on the contrary, 
the inflammation may exist after the matter discharged has ceased to 
be venereal. I have known cases where the inflammation and dis- 
charge have continued for twelve months, and with considerable vio- 
lence: in the mean time a free intercourse with women has not com- 
municated the disease. However, this is not an absolute proof that 
there is no virus in the discharge. 



These considerations relative to the return of the disease are very 
important, and it is oftentimes very painful to witness the incredulity 
of surgeons when conversing with their patients. 



CHAP. VIII. 



Observations on the Symptoms ichich often remain after Hie Disease is 

subdued. 

It often happens, after the virus is destroyed, and the venereal in- 
flammation removed, that some one, two, or more of the symptoms 
shall continue, and perhaps prove more obstinate than the original dis- 
ease itself. Some of these symptoms shall continue through life, and 
even new ones shall sometimes arise as soon as the first have'sub- 
aided. All these symptoms are commonly imputed by the patients 
themselves, and, what is still worse, by some of the profession, to 
the original disease having been ill treated. But, certainly, so far as 

* Vide pages 48 & seq. 



CHAP. VIII. OF GONORRHOEA. 99 

we are yet acquainted with the disease and method of cure, this is 
not true; for the methods of treatment, though numerous, may he 
said to be very similar; and we shall find these symptoms not to be 
consequences of any one mode of treatment, but that they happen 
indiscriminately after them all. Yet I can conceive that many con- 
stitutions, and particular parts, often require one mode of treatment 
in preference to another, and probably require modes that we are not 
as yet acquainted with; but if these peculiarities of constitution, or 
of parts, are not yet known, which must often be the case, the prac- 
titioner is not to be rashly accused of ignorance. 

In the Introduction I observed, that the venereal disease is capa- 
ble of calling into action such susceptibilities as are remarkably 
strong, and peculiar to certain constitutions, and countries; and that, 
as the scrofula is predominant in this country, some of the effects of 
gonorrhoea may partake of a scrofulous nature. 

The symptoms which continue after the virus is gone do not owe 
their continuance to the specific qualities of the virus, but to its ef- 
fects upon the parts, such as inflammation and its consequences; for 
the same degree of inflammation, arising from any other cause, 
would leave most of the same effects. But I suspect that the conti- 
nuance of- the discharge, called a gleet, is an exception to this; for 
we find that it is often cured by the same mode of action which 
would produce the other symptoms; that is, inflammation; and we 
find, in general, that a discharge brought on by violence of no speci- 
fic kind, does not last longer than the violence, even although the 
cause has been continued for some time, as is often the case during 
the use of bougies. 

The first of the continued symptoms may be reckoned the re- 
mains of the disagreeable sensations excited by the original disease. 

The second, the discharge called a gleet. 

The third, the chordee. 

The fourth, the irritable state of the bladder. 
» The fifth, the increase and hardness of the epididymis. 



The remarks on the gleet, contained.in this section, afford a further 
presumption, that venereal gonorrhoea does not cure itself. Mr. 
Hunter admits, that the gleet is often infectious. Is it not therefore 
a continuance of the same virulent action, after the inflammation has 
ceasn d, from the parts becoming accustomed to that action. lie ad- 
mits also, that a new inflammation, arising from a different cause, 
will cure it; that is, will supersede the virulent action. He also re- 
marks, that this remaining action of a discharge continuing after the 
inflammation has ceased, is in some measure peculiar to virulent go- 
norrhoea —The fair inference from all this seems, that the mflamma- 



108 OF GONORRIKEA. CHAP. VIII. 

tion attending gonorrhoea will cease of itself; yet if this inflamma- 
tion was firs; excited by the contagious action, that action, that is, the 
secretion of contagious matter, will remain till superseded by some 
new action. 



SECTION I. 

Of the Remains of the disagreeable Sensations excited by the original 

Disease. 

The disagreeable sensations which continue in the urethra and 
glans occur most frequently when the bladder has sympathized with 
the urethra during the disease; for then there are often the remains of 
the old shooting pains in the glans, or on its surface, which take their 
rise from the bladder. These, however, commonly go off, seldom 
Wng the forerunners- of any bad symptoms, and therefore, are not to 
be considered as part of the disease, but merely a consequence; yet 
they are often very troublesome and teazing to the patient, keeping 
his mind in doubt whether he is cured or not, which makes him fre- 
quently become the dupe of ignorant or designing men. 

As these remaining sensations vary considerably in their nature, 
perhaps no one method of treatment will always be proper. I have 
known a bougie, introduced a few times, take off entirely the disa- 
greeable sensations in die urethra; and I have known it do no good. 
Gentle irritating injections, used occasionally, will often alleviate, in 
some degree, those complaints. A grain of corrosive sublimate to 
eight ounces of water makes a good injection for this purpose; but all 
such applications are in general no more than palliatives. 

I have known the use of hemlock relieve the symptoms very much, 
and, in some cases, entirely cure them; while, in many others, it has 
not had the least effect. 

A blister applied to the perinaeum will entirely cure some of the 
remaining symptoms, even when they extend towards the bladder, as 
will be explained hereafter. Indeed, it appears to have more effect 
than any other remedy. A blister to the small of the back will also 
give relief, but not so effectually as when applied to the perineum. 

The following cases are remarkable instances of this: — A Portu- 
guese gentleman, about twenty-five years of age, had contracted a 
venereal gonorrhoea of which he was cured; but two. years after 
many of the symptoms still continued, and even with considerable 
violence. The symptoms were the following: a frequency in mak- 



SECT. I. OP 60N0RRH0SA 101 

ing water, and, when the inclination came on, he could not retain it 
a moment; a straining, and pain in the bladder after voiding it; a 
constant pain in the region of the bladder; a shooting pain in the ure- 
thra, which extended often to the anus; strange sensations in the pe- 
rinaeum; a sense of weariness in the testicles; and if he at any time 
pressed his thighs close together, the pain or sensation in the peri- 
naeum was excited. It was supposed at Lisbon that he had the 
stone, and he came over to London for a cure of that disease. He 
was examined, but no stone was found. He was ordered to wash the 
external parts every morning with cold water, which he did for a 
fortnight, but found no benefit. I was consulted, and informed of all 
the above-mentioned circumstances. As a staff had been passed, 
there could be no stricture; however, I thought it was possible there 
might be a diseased prostate gland, and therefore examined him bj 
the anus; but found that gland of its natural size and firmness. As 
there was no visible alteration of structure any where to be found, 1 
looked upon the disease as only a wrong action of the parls, and 
therefore ordered a blister to be applied to the perinaeum, which be- 
ing kept open only a few days, all the symptoms were entirely re- 
moved. He retained his water as usual; all the disagreeable sensa- 
tions went off; and the blistered part was allowed to heal. About 
a fortnight after, he got a fresh venereal gonorrhoea, which alarmed 
him very much, as he was afraid it might bring back all his former 
symptoms, which however did not return, and he was soon cured of 
the gonorrhoea. He staid in London some time after, without any 
relapse. 

Another case was that of a gentleman's servant in the country. He 
had, from a venereal cause, a disagreeable sensation whenever he- 
made water ; also a running, and some degree of chordee ; which 
symptoms he had laboured under for a considerable time. He had 
gone through a course of mercury, which lasted two months, on a 
supposition that the venereal virus had not been destroyed, but with- 
out benefit. He had, after that, been bled ; used powders of gum 
arabic and tragacanth ; and taken calomel in small doses, with no 
better success. He then had recourse to injections and bougies of 
all kinds, but with no better success. On the ground of the symp- 
toms not being venereal, but only wrong actions of the parts, a blis- 
ter was applied upon the perinaeum, repeated and kept open six days, 
upon which the symptoms totally disappeared, and had not recurred 
a twelvemonth afterwards. 

This practice is not only of service where there has been a preced- 
ing gonorrhoea, but 1 have found it remove, almost immediately, sup- 
pressions of urine from other causes, where the turpentines and opi- 
um, both by the mouth and anus, had proved ineffectual, and when 
the catheter had been necessarily introduced twice a day, to draw ofi 
the water. But of this more fully hereafter. 



102 OF GONORRHOEA. CHAP. VIII. 

Electricity has been found to be of service in some cases, and there- 
fore may be tried, either in the first instance, or when other means 
have failed. 



SECTION II. 

Of a Gleet. 

Whatever method has been had recourse to in the cure of the vene- 
real inflammation, whether injections have been used, or internal me- 
dicines, (mercurials, purgatives, or astringents,) it often happens that 
the formation of pus shall continue, and prove more tedious and diffi- 
cult of cure than the original disease. For, as I have already ob- 
served, the venereal inflammation is of such a nature as to go off of 
itself, or to wear itself out ; or, in other words, it is such an action of 
the living powers as can subsist only for a certain time. But this is not 
the case with a gleet, which seems to take its rise from a habit of ac- 
tion which the parts have contracted, and as they have no disposition to 
Lay aside this action, it of course is continued; for we find in those 
gonorrhoeas which last long, and are tedious in their cure, that this 
habit is more rooted than in those which go off soon. 

This disease, however, has not always the disposition to continue, 
for it often appears to stop of itself, even after every method has been 
ineffectually used. It is most probable that this arises from some ac- 
cidental changes in the constitution, not at all depending upon the na- 
ture of the disease itself. 

I have suspected that there was something scrofulous in some 
gleets. We find frequently that a derangement of the natural actions 
of a part will be the cause of that part falling into some new disease, 
to which there may be a strong tendency in the constitution. We 
find, that a cold, falling on the eyes, produces a scrofulous weakness 
in those parts, with a considerable discharge. There are often scro- 
fulous swellings in the tonsils from the same cause. 

This opinion of the nature of some gleets is strengthened by the 
methods of cure; for we find that the sea-bath cures more gleets than 
the common cold bath, or any other mode of bathing. I have never 
yet tried the internal use of those medicines which are generally given 
in the scrofula; but I have found sea-water diluted, and used as an 
injection, cure some gleets, though it is not always effectual. 

A gleet is generally understood to arise from aweakness; this cer- 
tainly gives us no idea of the disease, and indeed there is none which 
can be annexed to the expression. By mechanical weakness is un- 
derstood the inability to perform some action, or sustain some force. 
By animal weakness the same is understood. But when the expres- 



SECT. II. OP GONORRHOEA. 103 

sion is applied to the animal's performing an uncommon or an addi- 
tional action, I do not perfectly understand it. 

Upon this idea of weakness depended, in a great measure, the usual 
method of cure; but we shall find that the treatment, founded on 
this idea, is so far from answering in all cases, that it often does harm, 
and that a contrary practice is successful. 

A gleet differs from a gonorrhoea, first in this, that, though a conse- 
quence of it, it is perfectly innocent with respect to infection. Se- 
condly, when is is a true gleet it is generally different in some of ths 
constituent parts of the discharge, which consists of globular bodies 
floating or wrapti n a slimy mucus instead of a serum. But the ure- 
thra is so circumstanced as easily to fall back into the formation of 
pus, and this commonly happens upon the least increase of exercise, 
eating or drinking indigestible food, or any thing which increases the 
circulation or heats the patient. The virus, however, I believe, does 
not return; but of this I am not certain, for there are cases that make 
it very doubtful, as was before observed. 

I am inclined to suspect that a gleet arises from the surface of the 
urethra only, and not from the glands; for I have observed, in several 
instances, that when the passage has just been cleared, either by the 
discharge of urine, or by the use of an injection, a lascivious idea has 
caused the natural slime to flow very pure, which I do suppose would 
not have happened, if the parts, secreting the liquor, had assisted in 
forming the gleet. 

A gleet is supposed to be an attendant upon what we call a relaxed 
constitution; but I can hardly say that I have observed this to be the 
case; at least I have seen instances where I should have expected such 
a termination of a gonorrhoea, if this had been a general cause, but 
did not find it; and I have seen it in strong constitutions, at least in 
appearance, in every other respect. Gleets do not in all cases arise 
from preceding gonorrhoeas, but sometimes from other diseases of the 
urethra. A stricture in the urethra is, I believe, almost always at- 
tended with a gleet. It sometimes arises also from a disease in the 
prostate gland. 

When a gleet does not arise from any evident cause, nor can be sup- 
posed to be a return of a former gleet in consequence of a gonorrhoea, 
a stricture, or diseased prostate gland, is to be suspected; and inquiry 
should be made into the circumstances of making water; whether the 
stream is smaller than common; whether there beany difficulty in 
voiding it; and whether the calls to make it are frequent. If there 
should be such symptoms, a bougie, of a size rather less than common, 
ought to be used, which, if there is a stricture, will stop when it 
reaches it; and if it passes on to the bladder with tolerable ease, the 
disease is probably in the prostate gland, which should be next ex- 
amined. But more fully of both these complaints hereafter. 

This chapter, on the symptoms which remain after the cure of 



104 OF GONORRHOEA. OHAP. VIHT- 

gonorrhoea, should be perpetually attended to, as there are no com- 
plaints by which we may gain or lose more credit; but most ol all 
by the gleet. The only addition I can make to Mr Hunter's remarks 
is", to advise every practitioner to be particularly careful how he un- 
der-rates such diseases. To frighten a youth with the prospect of 
permanent injury from such a cause, is a piece of wanton cruelty; 
"but it is not less proper to admit with him the irksomeness of his 
situation, and to feel a part of his anxiety from so inconvenient a com- 
plaint. On this account, let us be cautious how we betray any wea- 
riness at the importunity of our patient. On the contrary, let us 
always reflect on his situation, and the difficulty of relieving him, and 
on the advantage which artful people will make of our apparent inat- 
tention. When we consider the variety of constitutions, and the va- 
rious conditions of the same constitution, we must not be surprised if 
a local chronic disease does not immediately give way to a remedy 
which we have generally found successful, nor should we continue 
to expect much from any remedy after a short unsuccessful trial. 
We should vary our plan more frequently than in acute or well mark- 
ed diseases, always recollecting, that in chronic-local diseases, 
whatever remedy is successful, usually shows its effects very early. A 
gentleman with whom I had tried many remedies unsuccessfully 
suddenly got well. I was very suspicious that his cure was not im- 
putable to me, as I had not seen him for some time. He candidly 
informed me that he had been cured by an injection of brandy and 
water, as strong as he could well bear it. Probably had I given 
him any other equally stimulating injection, instead of trusting to what 
are usually called astringents, I might have been equally successful. 
But what the reader should particularly caution himself against is, 
the remark that the gleet is perfectly " innocent with respect to in- 
fection." How such an expression escaped Mr. Hunter, I am at 
a loss to ascertain. Not only the remainder of the paragraph seems 
to contradict it, but several other passages, in which the difficulty of 
ascertaining the disease and its cessation is described. In a word, 
a gleet, like every other disease, should be accurately inquired into 
as to its cause; and as in every other chronic disease, the treatment 
should be varied, as the next section amply shows. 



SECTION III. 

Of the Cure of Gleets — Constitutionally — Locally. 

As this discharge has no specific quality, but depends upon the con- 
stitution of the patient, or nature of the parts themselves, there can 



SECT. III. OP GONOMtHCEA. 105 

be no certain or fixed method of cure; and as it is very difficult to find 
out the true nature of different constitutions, or of parts, it becomes 
equally difficult to prescribe with certainty the medicines that will 
best suit this disease; for so great is the variety in constitutions, that 
what in one case proves a cure, will in another aggravate the com- 
plaint. 

There are two ways of attempting the cure of this complaint, con- 
stitutionally, or locally. 

Medicines, taken into the constitution with a view to the cure of 
gleet, may be supposed to act in three ways; as specifics,* strength- 
eners, and astringents. 

The specific power of internal medicines upon those parts is not 
rery great; however, we find that some of them, such as the balsams, 
turpentines, and cantharides, are of use, especially in slight cases. 
I think I have been able to ascertain this fact, that when the balsams, 
turpentines, or cantharides, are of service, they are almost immedi- 
ately so; therefore, if upon trial they are not found to lessen, or to- 
tally remove the gleet in five or six days, I have never continued them 
longer. And even where they have either lessened or totally re- 
moved the gleet in that time, it will often recur upon leaving them 
off, and therefore they should be continued for some time after the 
symptoms have disappeared. I have known cases where the gleet 
has disappeared immediately upon the use of the balsam capivi, and 
recurred upon the omission of it; and I have also seen where that me- 
dicine has kept it off for more than a month, and yet it has recurred 
immediately upon laving it aside, and stopped again as quickly, when 
the patienUias returned to it. In such cases, the other methods of 
cure should be tried. The balsams may either be given alone, or 
mixed with other substances, so as to make them less disagreeable. 

The general strengthened of the habit need only be given when 
the parts act merely as parts of that habit. The whole being dis- 
posed to act properly, these parts are also disposed to act in the 
same way. By general strengthened are here meant, the cold bath, 
the sea-bath, the bark, and steel. Astringents, taken into the con- 
stitution, have no great powers; and if they had, they might be very 
improper, as any thing that could act with powers in the constitution 
equal to what would be necessary here, might very much affect many 
natural operations in the animal economy. The astringent gums 
and salt of steel are commonly given. 

The second mode of cure is by local applications. These may be 
divided into four, which are, specifics, astringents, irritating medi- 
cines, and such as act by derivation. 

• It may he necessary to remark here, t'.iat by specific T do not mean a speci- 
fic for the"(Hsease, but only such medicines as act specifically on the parts con- 
cerned, H9 the turpentines, cantharides, &c 



106 OF GONORRHCEA. CHAP. VIII, 

The specifics applied locally, we may reasonably suppose, will 
have greater effects than when given internally, because they may be 
applied stronger than can safely be thrown into the circulation. Of 
this, I think, I have had experience. 

The astringents, commonly used, are, the decoction of the bark, 
white vitriol, alum, and preparations of lead. The aqua vitriolica 
ccerulea, of the London Dispensatory, diluted with eight times its 
quantity of water, makes a very good astringent injection. The 
same observations that I made on the specifics are applicable to the 
astringents; I believe that they act nearly in the same manner, and 
have the same effect. What their mode of action is, it is difficult 
to say. 

When either of these methods have been used, and have had the 
desired effect, they should be continued for a considerable time after 
the symptoms have disappeared; and the time must be in proportion 
to the duration of the complaint, or the frequency of its returns. If 
it has been of long standing, we may be sure that the disposition to 
such a complaint is strong; and if it has returned frequently, upon 
the least increase of circulation, we may expect the same thing to 
happen again. Therefore, to correct the bad habit, it is necessary 
to continue the medicines a considerable time. 

Irritating applications are either injections or bougies, simple, or 
medicated with irritating medicines. Violent exercise may be con- 
sidered as having the same effect. Such applications should never 
be used till the other methods have been fully tried and found un- 
successful. They differ from the foregoing by producing at first a 
greater discharge than that which they are intended to cure; and 
the increased discharge may or may not continue as long as the ap- 
plication is used. It becomes, therefore, necessary to inquire how 
long they are to be used, to produce a cure of the gleet. That time 
will generally be in proportion to the violence used, and the nature 
of the parts which form the matter; and according to the disposition 
being strong or weak joined to its duration, and the greater or less 
irritability of the parts. If the parts are either weak or iiritable, 
or both, an irritating injection should not be used; if strong, and not 
irritable, it may be used with safety. In this last case, if it is an 
injection that stimulates very considerably, perhaps it may be suffi- 
cient to use it twice or thrice a day. I knew a gentleman, who 
threw into the urethra, for a gleet of two years standing, Goulard's 
extract of lead undiluted, which produced a most violent inflamma- 
tion; but when the inflammation went off, the gleet was cured. Two 
grains of corrosive sublimate to eight ounces of water are a very 
good irritating injection. 

If it is a gleet of long standing, it may require a week or more to 
remove it, even with an irritating injection; and if the injection is 
less irritating, so as to give but little pain, and to increase the dis- 
charge in a small degree, it may require a fortnight. But one pre- 



SECT. III. OF GONORRHOEA. 107 

caution is very necessary respecting the use of irritating injections; 
it should be first known, if possible, that they will do no harm. To 
know this may be difficult in many cases; but the nature of the parts 
is to be ascertained as nearly as possible, that is, whether they had 
ever been hurt before by such treatment; whether they are so suscepti- 
ble of irritation, as that the irritation may be expected to run along 
the urethra and produce symptoms in the bladder; for in such cases 
irritating applications do not answer, but, on the contrary, often pro- 
duce worse disorders than those which they were meant to cure. 

Bougies may be classed with the irritating applications; and in 
many cases they act very violently as such. They appear to be 
more efficacious than injections; but they require longer time to pro- 
duce their full effect. A simple, or unmedicated bougie is, in gene- 
ral, sufficient for the cure of a gleet, and requires a month or six 
weeks application before the cure can be depended on. If bougies 
are made to stimulate otherwise than as extraneous bodies, then a 
shorter time will generally be sufficient. Probably the best mode of 
medicating them would be by mixing a little turpentine, or a little 
camphor with the composition, so as to act specifically on the parts; 
but great care should be taken not to irritate too much. 

The size of the bougie should be smaller than the common, and 
need only be five or six inches long, as it seldom happens that a 
greater extent of the urethra has the disposition to gleet; but no harm 
will arise from passing a bougie of the common length through the 
whole extent of she urethra. 

In the cure of a gleet, attempted by means of the bougie, we have 
no certain rules to direct us when it should be left off; as the dis- 
charge will often continue as long as the bougie is used. If, upon 
leaving off the bougie after the use of it for several weeks, the run- 
ning ceases, then we may hope there is a cure performed; but if it 
should not be in the least diminished, it is more than probable that 
bougies will not effect a cure, and therefore it is hardly necessary to 
have recourse to them again. Yet, if the gleet is in part diminished, 
it will be right to begin again, and probably it may be proper to in- 
crease the irritating quality of the bougie, in order to suit it to the 
diminished irritability of the parts. 

The fourth mode of cure is by sympathy, or by producing an irri- 
tation in another part of the body, which shall destroy the mode of 
action in the urethra. 

I knew a case of obstinate gleet attended with very disagreeable 
sensations in the urethra, especially at the time of making water, re- 
moved entirely by two chancres appearing upon the glans. The pa- 
tient had taken all the medicines commonly recommended, and had 
applied the bougie, without effect. 

A gentleman "informed me, that he had cured two persons of gleets, 
by applying a blister to the under side of the urethra; and I have 
known several old gleets, after having baffled all common attempts, 



105 OF GONORRHOEA. CHAP. VIII. 

cured by electricity. All these different methods of cure alter the 
disposition of the part. 

In whatever way the cure is attempted, rest or quietness in most 
cases is of great consequence; for, as I have observed, exercise is of- 
ten a cause, not only of its continuance, but of its increase and re- 
turn. But this idea is not to be too rigidly adhered to, especially in 
cases which have been treated unsuccessfully; as I have known some 
that have got immediately well by riding on horseback after long 
disuse of that exercise. 

Regularity and moderation in diet should be particularly attended 
to; for irregularities of this kind either hinder the cure, or bring on a 
return of the disease. 

Intercourse with women often causes a return, or increase of gleet, 
and in such cases it gives suspicion of a fresh infection; but the differ- 
ence between this and a fresh infection is, that here the return will 
follow the connection so close, as to be almost immediate, and that 
circumstance, joined with the other symptoms, will in general ascer- 
tain the nature of the discharge. 

The cure of the gleet in women is nearly the same as in men, ex- 
cept in the use of what I have called specifics to the parts; for as the 
gleet in women is principally from the vagina, I believe that this part 
is not more affected by the turpentines than other parts are; but as 
the vagina is less irritable than the urethra in men, the astringents 
which are applied to it may be considerably stronger. Neither can 
we use the bougie in cases of gleet in the vagina; and when the gleet 
is only from the urethra, I imagine it is hardly ever attended to in 
women. 



SECTION IV. 

Of the remaining Chordee. 

This symptom, I have already observed, often remains after every 
mark of the true virus is removed, and may or may not be attendant 
on any of the other continuing symptoms. 

Mercurial ointment, applied to the part, may be of service, and if 
joined with camphor, its powers will be increased. I have known 
electricity cure a chordee of long standing. If it is the spasmodic 
chordee that remains, bark should be given. 

I have never seen this form of the disease (the spasmodic chordee,) 
nor does Mr. Hunter describe it. 



• 



SECT. VJ. OF GONORRHOEA. 109 

SECTION V. 

Of the Continuance of tlie Irritation of the Bladder. 

The irritation of the bladder sometimes continues after every other 
symptom has ceased, and it may be an attendant upon all, or any of 
the other continuing symptoms; it seldom lasts with the same vio- 
lence, although it is often very troublesome. When this irritation is 
kept up with the same violence, the bladder itself may be suspected 
of being diseased; or it may arise from its connexion with other parts, 
such as the urethra, or prostate gland; for a stricture in the urethra 
coming on will prove the cause of its continuance, and a disease in 
the prostate gland will do the same. 

Neither of these diseases will probably follow the gonorrhoea so 
closely as to keep up this irritation, though perhaps they may have 
been taking place prior to the gonorrhoea, and so contribute to its in- 
crease and continuance, which may probably be ascertained by a his- 
tory of the patient preceding the present complaint; however, before 
the bladder itself is attempted to be cured, a bougie should be passed, 
and, if no stricture is found, then the prostate gland should be ex- 
amined, as shall be described. 

When the disease is in the bladder only, I think the pain is prin- 
cipally at the close of making water, and for a little while after. 
The cure of this symptom consists in opiate clysters, cicuta, bark, 
sea-bathing, and I should be inclined to recommend the application 
of a blister to the perinaeum in men. How far opiate clysters can 
affect the bladder in women a:, they do in men, I am not certain. 



SECTION VI. 

Of the remaining Hardness of the Epididymis. 

This symptom, I have observed, remains long after every other 
symptom is removed, and may continue even for life, but seldom or 
ever any bad consequences happen from it, if the vas deferens is not 
rendered impervious; and not even then if it is only in one testicle, 
the other being equal to all the purposes of generation. As this is the 
case, we must at once see, that no certain method of resolution is yet 
known. The application of the steam of hot water with camphor 
may be tried, especially in such cases as are not disposed to be per- 
manent; and the scrotum may be rubbed with mercurial ointment 
joined with camphor. But, in most cases, this practice will prove 
too tedious, or rather too inefficacious to be long persisted in. 



110 SUPPOSED CONSEQUENCES CHAP. I. 



PART III. 



CHAP. I. 



Of Diseases supposed to arise in Consequence of Venereal 
Inflammation in the Urethra of men. 

The gonorrhoea produces, or at least is supposed to produce, be- 
sides those disorders already mentioned, many others which are to- 
tally different from the original disease. How far they do all or any 
of them arise in consequence of this disease, is not clear; but as they 
are diseases of the urethra, and are both numerous and important, I 
mean to treat fully of them in this place. If any of these diseases 
arise from a gonorrhoea, they are most probably not the consequences 
of any specific quality in the venereal poison, but are such as might 
be produced by any common inflammation in those parts, as was ob- 
served of the continued symptoms. 

In this investigation we shall find some of the complaints arising 
out of each other, so that there is frequently a series of them. Thus, 
a stricture of the urethra produces an irritable bladder, a frequent 
desire to make water, increased strength of the bladder, a dilatation 
of the urethra between the bladder and stricture, ulceration, fistula; 
in perinaso, dilatation of the ureters, and enlargement of the pelvis of 
the kidneys, besides other complaints that are sympathetic, such as 
swellings of the testicle, and of the glands in the groin. I shall treat 
of the diseases of those parts in the order in which they most com- 
monly arise. 

It may be observed that most of these diseases, especiallv the di- 
minution of distensibility in the bladder, attack men advanced beyond 
the middle age, although many, if not all of them, are at times found 
in younger subjects, and the circumstance of their appearing at this 
period arises probably in some degree from a long habit of an unna- 
tural mode of life producing many diseases, such as gout; for cer- 
tainly such complaints do not so frequently take place amon* the 
more uncivilized nations. 

The most frequent disease in the urethra is an obstruction to the 
passage of the urine; it happens both in young and old, although 
most frequently in the latter. Before I begin to treat of this sub- 



CHAP. I. OF GONORRHOEA. Ill 

ject, I shall, for the better understanding of the whole, make some 
observations on the uses of this passage in its natural state. 

It may first be observed, that the urethra in man is employed for 
two purposes. On this occasion I may be allowed to make the fol- 
lowing general remark, that Nature has not been able to apply any 
one part to two uses with advantage, as might be illustrated in many 
instances in different animals. The animals, whose legs are con- 
trived both for swimming and walking, are not good at either, as 
seals, otters, ducks, and geese. The animals, also, whose legs are 
intended both for walking and flying, are but badly formed for either, 
as the bat. The same observations are applicable to fish, for the 
flying fish neither swims nor flies well; and whenever parts, intended 
for such double functions, are diseased, both are performed imper- 
fectly. This is immediately applicable to the urethra, for it is in- 
tended as a canal or passage both for the urine and the semen. The 
urine requires the simplest of all canals, and of no greater length 
than the distance from the bladder to the external surface, as we find 
the urethra in women, birds, the amphibia, and fish ; but the pas- 
sage for the semen in the quadruped required to be a complicated 
canal, and of a length capable of conveying the semen to the female, 
provided with many additional and necessary parts, as the corpus 
spongiosum urethrae, musculi acceleratores, Cowper's glands, pros- 
tate gland, and vesiculae seminales. As all these parts are to serve 
the purposes of generation, and as the diseases of this canal are prin- 
cipally seated in them, we at once see how much the urinary organs 
must suffer from a connexion with parts so numerous, and so liable 
to disease; and what adds to the evil is, that the actions of the uri- 
nary organs are constant, and absolutely necessary for the well-being 
of the machine, whereas the evacuation of the semen takes place only 
during a certain portion of life, is then only occasional, and never 
essentially necessary to the existence of the individual. The force 
of this observation is at once seen by making the comparison between 
the inconveniences that attend the expulsion of the urine in the male 
and in the female. 

The canal of the urethra is liable to such diseases as are capable of 
preventing in some degree the passage of the urine through it; and in 
some of these diseases the passage at last becomes completely ob- 
structed. In all cases there is a diminution of the size of the canal, 
hut in different ways. There are five modes of obstruction, four of 
which are diseases of the passage itself, the fifth is a consequence of 
the diseases of other parts. Three of the former are a lessening of 
the diameter of the passage; the fourth an excrescence in the pass- 
age; the.fif'h arises from the sides being compressed, which may be 
done either by exterior contiguous swellings, or by a swellii g of the 
pros! ate gland. 

V late theological writer has ventured to dispute the justice of this 



112 SUPPOSED CONSEQUENCES CHAP. I. 

remark; but the illustration of his objection produced, most unfortu- 
nately for him, a striking instance of the inconvenience of an organ de- 
stined for two purposes, namely, the mouth which serves the offices 
of the stomach and lungs. It cannot be necessary to remark how 
frequently these two offices interfere with each other so as to endanger 
life, and sometimes produce almost instant death. 



SECTION I. 

Of Strictures. 

The three first I shall now consider, of which the first is the true 
permanent stricture, arising from an alteration in the structure of a 
part of the urethra. The second is a mixed case, composed of a 
permanent stricture and spasm. The third is the true spasmodic 
stricture. Most obstructions to the passage of the urine, if not all, 
are attended with nearly the same symptoms, so that there are hardly 
sufficient marks for distinguishing the different causes. Few take 
notice of the first symptoms of a stricture till they have either be- 
come violent, or have been the cause of other inconveniences. For 
instance, a patient shall have a considerable stricture without ob- 
serving that he does not make water freely; he shall even have, in 
consequence of a stricture, a tendency to inflammation and suppu- 
ration in the perinaeum, and not feel any obstruction to the passage 
of his urine, nor suspect that he has any other complaint than the in- 
flammation in the perinaeum. In all of these obstructions the stream 
of water becomes small, and that in proportion to the obstruction; 
but this symptom,- though probably it is the first, is not always ob- 
served by the patient. In some the water is voided only in drops, 
and then it cannot escape notice; in others, the stream of urine is 
forked, or scattered: under such circumstances the passage should 
be examined with a bougie; and if one of a common size passes 
with tolerable ease, the fifth cause of obstruction is to be suspected, 
which will most probably be found to be a swelled prostate gland; 
for any other cause that can produce a compression of the sides of the 
urethra, sufficient to obstruct the urine, will be known to the patient, 
such as a tumour forming any where along the canal, or an inflam- 
mation along its sides. If, therefore, neither of these are known to 
exist, the prostate gland should be examined, as will be described 
hereafter. 

The spasmodic obstruction will commonly explain itself when the 
symptoms are well investigated; for the obstruction arising from this 
cause will not be permanent. These obstructions, but more particu- 



GIIAP. II. 



OP GONORRHOEA. H3 



larlv that from a permanent stricture, is generally attended with a 
discharge of matter or a gleet. This is of^n conaidi r I by h- pa- 
tient as the whole disease, and he applies to the surgeon for the cure 
of a gleet. The surgeon often perseveres in attempting lie cure of 
this disease; but, no success attending him, at last other symploms 
are observed, and a stricture is suspected either by the surgeon or pa- 
tient. In diseases of this passage, and also of the prostate gland and 
bladder, there is commonly an uneasiness about the perinaeum, anus, 
and lower part of the abdomen; and the patient can hardly cross his 
legs without pain. 



CHAP. II. 

Of the Permanent Stricture. 



In the permanent stricture,* the patient seldom complains till he 
can hardly procure a passage for the urine; and frequently has a con- 
siderable degree of strangury, and even other symptoms that happen 
in stone and gravel, which are therefore too frequently supposed to 
be the causes of the complaint. The disease generally occupies no 
great length of the passage; at least in most of the cases that I have 
seen, it extended no further in breadth than if the part had been sur- 
rounded with a piece of packthread; and in many it had a good deal 
of that appearance. I have, however, seen the urethra irregularly 
contracted for above an inch in length, owing to its coats, or internal 
membrane, being irregularly thickened, and forming a winding 

a A stricture does not arise in all cases from an equal contraction of 
the ureihra all round, but in some from a contraction of one side, 
which probably has given the idea of its having arisen from an ulcer 
on that side. This contraction of one side only throws the passage to the 
opposite side, which often renders it difficult to pass the bougie. The 
contracted part is whiter than any other part oi the urethra, and is 
harder in its consistence. In some few cases there are more stric- 
tures than one. I have seen half a dozen in one urethra; some of 
which were more contracted than others; and indeed many urethras, 
that have a stricture, have small tightnesses in other parts of them. 
This we learn from successive resistance felt in passing the bougie. 

Every part of the urethra is not equally subject to strictures; lor 
there appears to be one part which is much more liable to them than 



' Vile plate I, fig- 1 
P 



114 SUPPOSED CONSEQUENCES CHAP. It. 

the whole of the urethra besides, that is, about the bulbous part. We 
find them, however, sometimes on this side of the bulb, but very sel- 
dom beyond it. I never saw a stricture in that part of the urethra 
which passes through the prostate gland; and the bulb, besides being 
the most frequent seat of the disease, has likewise strictures formed 
there of the worst kind. They are generally slow in forming, it be- 
ing often several years from their being perceived before they be- 
come very troublesome. 

The same stricture is not at all times equally bad; for we find 
that, in warm weather, it is not near so troublesome as in cold. 
These changes are often very quick. A cold day, even an hour of 
cold weather, shall produce a change in them; and the same stric- 
ture is almost always worse in winter than in summer. However, 
this observation is not free from exceptions; I knew one case that 
was always worse in the summer. There are. other circumstances, 
besides cold, that make a stricture worse. A gentleman, who had 
an ague, always found the stricture increased during the fit. It is 
also increased by drinking, violent exercise, and by the retention of 
urine after an inclination to void it has been felt. This last cause 
is often so great as to produce a total stoppage for a time. It is 
sometimes rendered much worse by a small calculus passing from 
the bladder, of the formation of which this stricture was probably 
the cause. The calculus not passing will produce a total stoppage of 
urine, the cause of which can hardly be known at the time; and if 
known, it could not be remedied without an operation.* 

It is impossible to say what is the cause of that alteration in the 
structure of the urethra which diminishes the canal: it has been 
ascribed to the effects of the venereal disease, and often to the me- 
thod of cure. But I doubt very much if it commonly, or even ever, 
arises from these causes; yet as most men have had venereal com- 
plaints some time or other, it is natural to ascribe the stricture to 
them; and therefore it may be very difficult to refute this opinion. 
Many reasons, however, can be given why we should suppose, that it 
is not commonly a consequence of a venereal inflammation. Stric- 
tures are common to most passages in the human body; they are often 
to be found in the oesophagus; in the intestines, especially the rec- 
tum; in the anus; in the prepuce producing phymosis; in the lachry- 
mal duct, producing the disease called fistula Tachrymalis, where no 
disease had previously existed. They sometimes happen in the ure- 
thra where no venereal complaint has ever been. I have seen an in- 
stance of this kind in a young man of nineteen, who had had the com- 
plaint for eight years, and which therefore began when he was only 
eleven years of age. It was treated at first as stone or gravel. He 
was of a scrofulous habit, the lips thick, the eyes sore, a thickened 
cornea of one eye, and the general habit weak. This stricture was 

* Vide plate IV. 



UHA.P. II. OF GONORRHOEA. 115 

in the usual place, about the membranous part of the urethra. I 
have seen an instance of a stricture in the urethra of a boy of four 
years, and a fistula in perinaeo in consequence of it. They are us 
common to those who have had the gonorrhoea slightly, as those who 
have had it violently. 

I knew a young gentleman who had a very bad stricture. He had 
had several gonorrhoeas, but they were so slight that they seldom 
lasted a week; nor in any of them did the pain extend beyond the 
fraenum; but the stricture was about the membranous part. Cases 
of this kind occur every day. They are never found to come on dur- 
ing the venereal inflammation, nor for some time after the infection is 
gone. There have been thirty, and sometimes forty, years between 
the cure of a gonorrhoea and the beginning of a stricture, the health 
being all that time perfectly good. If they arose in consequence of 
the venereal inflammation, we might expect to find them of some ex- 
tent, because the venereal inflammation extends some way; and Ave 
should also expect to find them most frequent in that part of the ure- 
thra which is most commonly the seat of the venereal disease. But 
I remarked before, that they are not so frequent there as they are in 
other parts of the urethra. 

It is supposed by many, that strictures arise from the use of in- 
jections in the cure of the gonorrhoea; but this opinion appears to 
be founded in prejudice; for I have seen as many strictures after go- 
norrhoeas that have been cured without injections, as after those 
cured with them. 

Such modes of accounting for strictures give no explanation of 
those where there lias been no previous gonorrhoea, or where the go- 
norrhoea has not been cured by injections; and indeed, if we consi- 
der the mode of cure of strictures, we must see that an injection is 
a mild application to the urethra, compared to a bougie; yet a bou- 
gie has never been supposed, or known to be the cause of a stric- 
ture. Further, some have injected by mistake very irritating li- 
quors, such as the undiluted extract of lead, and caustic alkali, with- 
out giving the least tendency towards a stricture, although they pro- 
duced violent inflammation, and even sloughing of the internal mem- 
brane of the urethra. 

By many they have been supposed to have arisen from the heal- 
ing of ulcers in the urethra; but as I never saw an ulcer in these 
parts, except in consequence of a stricture, and as I do not beheve 
there ever is an ulcer in the case of a common gonorrhoea, I can 
hardly subscribe to that opinion. 

The subject of strictures is at this time a matter of no inconsi- 
derable controversy, and not necessarily connected with the venereal 
disease For this reason, and because I have but little practical 
knowledge on the subject, I shall dismiss it in a very few words, aua 



116 SUPPOSED CONSEQUENCES CHAP. II. 

with a reference to those writers who have taken up the subject 
since Mr. Hunter wrote. 

Mr. Hunter mav be considered as the first person who has given 
a rational history of the disease; showing that though it may some- 
times be excited by the inflammation of gonorrhoea, yet that 
such a cause is neither necessary nor constant. His frequent dis- 
sections of urethra?, particularly in old soldiers, some of whom had 
laboured for years with different complaints in that organ, gave him 
great opportunities of examining the alteration of the parts under 
every circumstance. This knowledge he turned to very important 
practical use, in the extensive field in which he was engaged; and it 
is worth remarking, that after all the controversy which has lately 
engaged the surgical world, the whole seems to end in a confirmation 
of his opinions and practice. 

Mr. Home, having had the happiness of being domesticated with 
Mr. Hunter, could not but learn the result of his practice better than 
any other person. This seems to have given him a confidence in the 
application of the caustic, which either Mr. Hunter had not when 
he wrote, or which he did not think sufficiently matured for holding 
out to the world. Mr. Home's subsequent experience confirmed him, 
not only in the safety of the caustic, and its superior advantage, but 
also induced him to think, that the mere dilation of the urethra by a 
bougie was only a temporary cure, which ought to be rendered per- 
manent by destroying the strictured part. He found, also, that so 
various and complicated are the sympathies of the urethra with the 
neighbouring parts, and even with the whole constitution, that the 
disease often existed without the knowledge or suspicion of the pa- 
tient. Hence, by applying caustic to the urethra, he was enabled to 
relieve abscesses, which had withstood common remedies, in perinaeo 
and other parts, and also what had been considered as irregular in- 
termittents. Mr. Home's mode of applying the caustic, though 
bolder, was similar to Mr. Hunter's: he used also the lunar caustic, 
or argentum nitratum. 

Mr. Whately has since proposed a different mode of causticating 
the parts. The lunar caustic, he remarks, kills the part; after which 
a slough,' and consequent separation are necessary. But by applying 
kali purwn, formerly called lapis infernalis, he proposes to form an 
immediate combination with the animal matter, which, united with 
the alkali, forms a soap. Whether all the advantages held out by 
that gentleman really result from this change, must be determined by 
gentlemen who have larger opportunities of practice. 

These two writers, and particularly Mr. Home, by his well known 
advantages under Mr. Hunter, and his subsequent extensive prac- 
tic( , had so comple" d the public mind, that the caustic 

seem<d likely to be in as familiar use in the urethra as upon com- 
urfaces. After this, Dr. Andrews, who had been house pupil 
to Mr. Hom^ settled at Madeira, where he had large opportunities 



CHAP. if. OF GONORRHtEA. 117 

of trying a remedy which had never before been used in that island. 
His success induced him to publish several valuable cases, which 
were well received, as further confirmation of the safety of the caus- 
tic, and of its success in cases in which the common bougie had long 
been tried in vain. 

It is not to be wondered if some inconveniences arose in unskilful 
hands, from the very liberal use of so powerful a remedy; since even 
Mr. Home's candour induces him to admit, that hemorrhages had 
sometimes occurred which gave him considerable trouble. Still, 
however, though the practice lost some of its popularity, nothing was 
produced to the public which might impede its general prevalence. 

At length Mr. Wadd offered himself as a champion for restoring 
that cautious practice which is so conspicuous in Mr. Hunter. 
Though this was the first occasion on which he had appeared before 
the public as a writer; yet his calm mode of comparing each author 
with himself and with others; his striking facts; the perspicuity of 
his language; and his lucid arrangement; all conspired to render his 
pamphlet highly popular. These combined events seem to promise 
a restoration of Mr. Hunter's method: for though probably the suc- 
cess with which some practitioners have used the caustic may induce 
them to undervalue the dangers described by others, yet it must not. 
be omitted, that the candour of some gentlemen has induced them to 
acquaint the world with difficulties which had occurred to them after 
they had given their decision in favour of that practice. 

If I might offer any judgment of my own, it can only be from the 
prevalence of general opinion, as far as can be collected in the me- 
tropolis, and from what I witnessed in Dr. Andrews's practice in Ma- 
deira. By the former it would appear, that the use of the caustic 
was atone time too indiscriminate; by the latter that there are cases 
in which the common bougie is insufficient,, yet which yield to the 
caustic. Under such circumstances, it seems reasonable to try the 
common bougie first, and afterwards to consider the application of 
the caustic like any other operation, that is, to explain to the patient 
the necessity of referring to it, the danger that sometimes attends it, 
and to leave the decision to himself. Such seems to have been Mr. 
Hunter's plan; and to this practitioners seem daily disposed to re- 
turn. 



CHAP. II. 



118 SUPPOSED CONSEQUENCES 

SECTION I. 

Of the Bougie. 

The bougie, with its application, is perhaps one of the greatest 
improvements in surgery which these last thirty or forty years have 
produced. When I compare the practice of the present day with 
what it was in the year 1750, I can scarcely be persuaded that I am 
treating the same disease. I remember, when about that time, I was 
attending the first hospitals in this city, the common bougies were 
either a piece of lead,* or a small wax candle; and although the pre- 
sent bougie was known then, yet a due preference was not given to it, 
or its particular merit understood, as we may see from the publica- 
tions of that time. . . 

Daran was the first who improved the bougie and brought it into 
general use. He wrote professedly on the diseases for which it is a 
cure, and also of the manner of preparing it; but he has introduced 
so much absurdity in his descriptions of the diseases, the modes ol 
treatment, and of the powers and composition of his bougies, as to 
create disgust. However, this absurdity has been much more effec- 
tual in Introducing the bougie into universal use, than all the real 
knowledge of that time, directed by good sense, could have been. 
Such extravagant recommendations of particular remedies an not a* 
all times without their use. Inoculation would have still been prac- 
tised with caution, had it not been for the enthusiasm of the Suttons. 
Preparations of lead would not have been so universally applied, if 
they had not been recommended by Goulard in the most extravagant 
terms; nor would the hemlock have come into such general use, if 
its true merits only had 'been held forth. Improvements are often 
over-rated; but they come to their true value at last. Sutton has told 
us, that the cold regimen, in extreme, is infinitely better than the old 
method; but from general practice we have learned that moderation 
is best, which is all we yet know. 

When Daran published his observations on the bougie, every sur- 
geon sat to work to discover the composition, and each conceived 
that he had found it out from the bougies he had made producing the 
effects described by Daran. It never occurred to them that any ex- 
traneous body, of the same shape and consistence, would do the same 
thing. 

* When lead was used in place of bougies, it has happened that a piece of 
the end has broken off in the bladder, which lias been dissolved by injecting 
quicksilver. I at first suspected that quicksilver could not come in contact 
with lead, while in water, so as to dissolve it, but upon making the experiment 
I found it succeeded. 



SECT. II. OF GONORRHOEA, 119 

SECTION II. 

Of the Treatment of the Permanent Stricture. 

The cure of the permanent stricture is, I believe, to be accomplish- 
ed only by local applications. Mercury has been given upon the er- 
roneous supposition of its being venereal; but without success. The 
cure is either a dilatation of the contracted part, or a destruction of 
it by ulceration, or escharotics. The dilatation is performed by the 
bougie; and this is seldom or ever more than a temporary cure; for 
although the passage may be dilated sufficiently for the urine to pass, 
yet there is always the original tendency to contraction, which gene- 
rally recurs sooner or later. * The ulcerative process is also effected 
by a bougie, and the destruction by escharotics is by means of caus- 
tics. It often happens in strictures, that the passage is so diminished 
as hardly to allow any water to pass, producing often a total stoppage; 
nor will a bougie immediately pass; and if it can be made to pass, 
yet no water follows it when withdrawn. In such cases, therefore, 
we must have recourse to the means that afford a temporary relief; 
such as the warm bath, which counteracts the effects of cold, and 
quiets any spasms that may have taken place in the parts, and clysters 
with opium, which have still more effect. Producing an evacuation 
by stool often lessens the spasm; for a' spasmodic suppression of 
urine frequently arises from a constipation, even where there is no 
stricture. 

The cure by dilatation is, I imagine, principally mechanical, when 
performed by bougies, the powers of which are in general those of 
a wedge. However, the ultimate effect of them is not always so 
simple as that of a wedge upon inanimate matter; for pressure pro- 
duces action of the animal powers, either to adapt the parts to their 
new position, or to recede by ulceration, which gives us two very dif- 
ferent effects of a bougie, and of course two different intentions in ap- 
plying them; one to produce dilatation, the other ulceration; which 
last is not always so readily effected. 

It generally "happens, as has been already observed, that the dis- 
ease has gone considerable lengths before application has been made 

* In cases of stricture, when a patient applies for relief, it may often be pro- 
per to inquire into the history of the case, previous to the passing of a bougie ; 
especially to inquire if he ever used bougies before ; if he has, then to inquire 
into the 'result ; if they passed readily, or if they did not pass the stricture at 
all : if the first, then nothing further need be asked; but if the last, then to in- 
quire if lie or his surgeon observed that they were gaining ground with the 
bougie, viz. If the bougie went further in before it was left off than at first ; 
if SO, then to ask him how far. If they have visibly gained ground without get- 
ting through the stricture, I am afraid that the use of the bougie must not be 
pursued, because it ismost probable that a new passage has been formed, which 
makes the passing of the bougie into the stricture impossible. 



120 SUPPOSED CONSEQUENCES CHAP. II. 

for a cure, and therefore the stricture has become considerable; in so 
much, that it is often with great difficulty that a small bougie can be 
made to pass. If the case is such as will readily admit the end of a 
small bougie to pass, let it be ever so small, the cure is then in our 
power. It often happens, however, that the stricture is such as will 
resist the passing of a small bougie at first, and even after repeated 
trials. Yet it is necessary to persevere with the small bougie; for 
sometimes it happens, that the passage through the stricture is not in 
a line with the urethra itself, which of course obstructs the bougie; 
such strictures, I suspect, are not equally placed all round so as to 
throw the small passage remaining into the centre of the canal. 

In many cases, where the stricture is very considerable, much 
trouble is given by occasional spasms; which either resist the bougie 
altogether, or will only let a very small one pass; though at another 
time they will admit one larger. In such cases 1 have been able to 
get the point of the bougie sometimes to enter, by rubbing the peri- 
nseum externally with the finger of one hand, while I pushed the bou- 
gie on with the other. This, though it does not always succeed, yet 
is worth the trial. Whether it alters the position of the stricture, so 
as to give entrance to the point of the bougie, or by sympathy removes 
the spasm, I will not absolutely determine; but, I believe, it rather 
acts by sympathy. In such cases of spasm in the stricture, I have 
often succeeded by letting the bougie remain a little while close to 
the stricture, and then pushing it on; this mode so often succeeds, 
that it should always be attempted when the bougie does not pass, or 
only passes occasionally. This will be mentioned more fully when we 
shall consider the spasmodic stricture. 

The spasm may probably be taken off by dipping the glans penis 
into cold water, which succeeds sometimes in the common stran- 
gury; but this cannot be so easily done while a bougie is in the 
passage. 

In cases of a permanent stricture, though the bougie does not at 
first pass, yet, after repeated trials, it will every now and then find 
its way, which helps to render a future trial more certain and easy. 
It however too often happens, that the future success does not imme- 
diately depend upon passing the bougie once or twice; for it shall 
pass to-day and not to-morrow; and this uncertainty shall last for 
weeks, notwithstanding every trial we can make; yet I may observe, 
that in general its introduction becomes gradually less difficult, and 
therefore in no case should we despair of success. It is imagined 
by some that the best time for trial in these cases is just after mak- 
ing water, as the passage is supposed to be clear and more in a straight 
line; but this is not confirmed by practice. 

It is not an easy matter in cases where the passage is very small, 
to know whether the bougie has entered the stricture or not; for such 
slender bougies as must generally be used at first, bend so very 
easily, that the introducer is apt to think it is passing, while it is 



SECT. II. OF GONORRHOEA. 121 

only bending. A surgeon, however, should in general first make 
himself acquainted with the situation of the stricture, by a common 
sized bougie, and afterwards make use of a smaller one, and when he 
comes to the stricture, push gently, and for a little time only. If 
the bougie has passed further into the penis, he will know how far it 
has entered the stricture by faking off the pressure from the bougie; 
for if it recoil he may be sure that it has not passed, at least has not 
passed far, but only bent; for the natural elasticity of the bougie, and 
the direction of the passage having been altered by it, will force it 
back again. But if it remain fixed, and do not recoil, he may be 
sure that it has entered the stricture. 

In using a very small bougie, however, these observations are not 
so applicable, for it may be bending, or bent, without being percepti- 
ble. It often happens, that a bougie will enter only a little way, 
perhaps not more than one tenth of an inch, and then bend if the 
pressure be continued. To determine whether this be the case, it 
is necessary to withdraw 7 the bougie and examine its end; if the end 
be blunted, we may be sure the bougie has not entered in the least ; 
but if it be flattened for an eighth or tenth of an inch, or grooved, or 
have its outer waxy coat pushed up for that length; or if there be a 
circular impression made upon the bougie, where the stricture is, or 
only a dent on one side, both of which last I suspect arise from spasm 
at the time, we may then be sure that it has passed as far as these 
appearances extend. It becomes then necessary to introduce ano- 
ther exactly of the same size, and in the same manner, and to let it 
remain as long as the patient can bear it, or convenience will allow; 
and by repeating this we may overcome the stricture. Sometimes we 
can judge of its having entered the stricture, by pulling it gently out; 
for if it stick a little at the first pull, we may be certain it has en- 
tered; but the appearance of the bougie itself will give the best in- 
formation.* In such cases I have always directed my patient to 
preserve the bougie for my inspection, exactly in the same form ir 
was when it was withdrawn. But when it passes with ease, this 
nicety is not necessary. 



* It may be remarked, that there are some lacunae (Vide plate I. fig. 2.) near, 
and also a little way from, the glans penis, which often stop the bougie, and 
give at first the idea of a stricture. I have known them taken for such ; and 
when the bougie stops so near to the glans this is to be suspected, and there- 
lore we should vary the direction of the point of the bougie, bearing it against 
the under side of the urethra. When the bougie stops in one of those lacunas, 
I think that the patient appears to have more pain than from a real stricture. 
The valvular part of the prostate gland formed by disease (Vide plate V.) very 
often obstructs the bougie, and is taken for a stricture by those who are not 
well acquainted with the different obstructions in this canal; and by those who 
are, it is a means of discovering disease in this part ; and indeed in a na- 
tural state of parts, I think I can ascertain when I come to this part with a 
bougie. 



\22 SUPPOSED CONSEQUENCES CHAP. II. 

The time that each bougie ought to remain in the passage, must 
be determined by the feelings of the patient; for it should never give 
pain, if possible. To go beyond this point is to destroy the inten- 
tion, to increase the very symptoms that are meant to be relieved, 
and to produce irritation, which for a time renders the further appli- 
cation of the bougie improper. While the bougie is passing, if the 
patient feel very acutely, it should not be left in the urethra above 
five, or at most ten minutes, or not so long if it give great pain; and 
each time of application should be lengthened so gradually, as to be 
insensible to the feelings of the patient, and the irritability of the 
parts. I have known it days, nay in many patients weeks, before 
they could allow the bougie' to remain in the passage ten, or even 
five minutes, and yet in time they have been able to bear it for hours, 
and at last without any difficulty. The best time to let it remain in 
the passage is when the patient has least to do; or in the morning, 
while he is in bed, provided he can introduce it himself. 

The bougie should be increased in size, according to the facility 
with which the stricture dilates, and the ease with which the patient 
bears the dilatation. If the parts are very firm, or very irritable, the 
increase of the size of the bougie should be slow, gradually stealing 
upon the parts, and allowing them to adapt their structure to the in- 
creased size. But if the sensibility of the parts will allow of it, the 
increase of the size of the bougie may be somewhat quicker, though 
never more quick than the patient can bear with ease. The increase 
should be continued till a bougie of the largest size passes freely; nor 
should this be laid aside till after three weeks, or a month, in oi'.ii-i-to 
habituate the dilated part to its new position, or to take off the habit 
of contracting from the part as much as possible; but, as was observed 
before, the permanency of this cure can seldom be depended upon. 

Instead of proceeding with the caution recommended, it has been 
practised with success for a time, to force a common sized bougie 
through a stricture that only allowed a small one to pass. This, I 
suppose, either tore the stricture or weakened it by stretching it sud- 
denly, so as to render it unable to recover its contractile power for a 
considerable time after. I have seen where this has produced good 
effects, and for a time removed the permanen stricture, and prevented 
spasm. This is a practice, however, which I have never tried; 
having always preferred the mild treatment where I could pass a 
bougie. 

I have known the passing of the bougie remove, almost imme- 
diately, a swelling of the testicle, which had arisen from the stric- 
ture; therefore, such a symptom should not prevent the use of the 
bougie. 

In cases of strictures, where the bougie is used, the patient is 
commonly in other respects well, and is with difficulty persuaded to 
restrain from his common habits, often making too free in eating, 
drinking, and exercise; which are all in many cases pernicious, more 



SECT. III. OF GONORRH(EA. 123 

especially where inflammation and suppuration have taken place. It 
is therefore the duty of the surgeon to restrict the patient for some 
time within certain bounds, till he finds by trials what the parts are 
capable of bearing without producing inflammation. 



SECTION III. 

Of the Cure of Stricture by Ulceration. 

The cure of a stricture by means of ulceration is likewise effected 
by a bougie. This method may be employed both in cases where a 
bougie will, and where it will not pass. In the first case, there is 
not the same necessity for ulceration as in the second, because, where 
a bougie will pass, there is no immediate danger arising from the 
stricture, which may therefore be dilated, as has been already de- 
scribed But if this metlwd should be preferred to a slow dilata- 
tion, which allows the parts time to adapt themselves to their new 
position, the stricture may be destroyed by producing ulceration in 
the parts, especially if they are not irritable, but admit of considera- 
ble violence. 

When this is intended, the bougie should be introduced as far into 
the stricture as possible, and the size of it increased as fast as the 
sensations of the patient can well bear. This will produce ulcera- 
tion in the part pressed, which is a more lasting cure, because more 
of the stricture is destroyed than when the parts are simply dilated. 
I believe, however, there are few patients that will submit to this 
practice ; and indeed few will be able to bear it; for I have seen it 
bring on violent spasms in the part, which have produced suppression 
of urine, and proved very troublesome. Therefore, as there is no 
absolute necessity in such cases for pursuing this method, I do not 
recommend it as a general practice, although there have been cases 
in which it has succeeded. Where this method is to be practised, it 
might probably be right to accustom the passage to a bougie for some 
time before such violence is used. 

If the smallest bougie, which can possibly be made, cannot be 
made to pass by some degree of force, dilatation becomes impracti- 
cable, and it is necessary that something else should be done for the 
relief of the patient; for the destruction of the stricture must be 
effected. In many cases it may be proper to attempt this by ulcer- 
ation of the part; for we find, from experience, that a stricture may 
be removed by the simple pressure of a bougie. This effect must 
arise from the irritation of absorption being given to the diseased 



124 SUPPOSED CONSEQUENCES CHAP, th 

part, which, from the stricture not being an originally formed part, nor 
having any power of resistance equal to the original one, is more 
susceptible of ulceration, and thereby is absorbed. The bougies, 
which are only to produce ulceration in consequence of their being 
applied to the stricture, need not to be so small as in the former cases, 
as they are not intended to pass; and by being of a common size, they 
will also be more certain in their application to the stricture. The 
force applied to a bougie, in this case, should not be great; for a stric- 
ture is the hardest part of the urethra; and if a bougie is applied with 
a considerable degree of pressure, and left in the passage, it some- 
times happens that the end of it slips off the stricture before there is 
time for ulceration, and makes its way into the substance of the 
corpus spongiosum by the side of the stricture ; and if the pressure 
be continued still longer, it will make a new passage beyond the stric- 
ture in the corpus spongiosum urethras.* This more readily hap- 
pens if the stricture be in the bend of the canal, as in such cases the 
bougie can hardly be applied exactly to it, not having the same 
curve. Such mischief I have seen more than once; and sometimes 
the bougie has been pushed so far as to make its way into the 
rectum. 

It often requires a considerable time before the whole is so far 
ulcerated as to admit the bougie, and this tires the patient, and al- 
most makes him despair of a cure. In this process great attention 
should be paid to the seeming progress of the cure; for if it appears 
to the surgeon that he is gaining ground by the bougie passing fur- 
ther in, and yet the patient does not make water better in the least, 
then he may be sure that he is forcing a new passage. f 

When the stricture has so far yielded to, these means as to admit 
a small bougie, the dilatation is to be made as in the former case 
where a bougie passed at first. Whenever a bougie of a tolerable 
size passes with ease, and the parts and patient have become accus- 
tomed to it, it is no longer necessary that the surgeon should continue 
to pass it; the patient may be allowed to introduce bougies himself; 
and when he can do it readily, the business may be trusted to him, 
as he can make use of them at the most convenient times, so that they 
may be applied longer at a time and oftener, the surgeon only attend- 
ing occasionally. This practice of the patient under a surgeon's 
eye, by which he is taught how to pass them, becomes more neces- 
sary, as strictures are diseases that commonly recur; and therefore 
no man, who has ever had a stricture, and is cured of it, should rely 
on the cure as lasting, but should be always prepared for a return; 

* Vide plate IT. 

f This makes it necessary in all cases of strictures where bougies will not 
pass, to be very particular in our inquiries, whether the patient has used 
bougies formerly; and whether there may not be reason to believe that thev 
had taken a wrong direction. 



SECT. HI. OF GONORRHOEA. 125 

and should always have some bougies by him. He should not go a 
journey, even of a week, without them; and the number should be 
according to the time he is to be absent, or to the place whither he is 
going; for in many parts of the world he cannot be supplied with them. 
The bougies for such purpose should be of different sizes, as it is un- 
certain in what degree the disease may return. 

Bougies, in all cases, from their shape, and from the action of the 
parts, readily slip out, whereby the cure is retarded; but it is much 
worse when they pass into the bladder; which can only take place 
in cases where the stricture is in some measure overcome. The con- 
sequence of a bougie passing into the bladder must at once appear in its 
fullest force to every one; it subjects the patient in most cases to be cut 
as for the stone; and, indeed, if it is either not soon thrown out, or cut 
out, it becomes the basis of a stone. A young man was cut for a bougie 
only a fortnight after it had passed into the bladder, and it was almost 
wholly crusted over with calculous matter. Bougies have been known 
to be forced out of the bladder along with the water by the action of 
that viscus, and in several folds. It is probable that the bladder in a 
natural state has not power sufficient to perform such an action; but 
we shall show, that, in cases of strictures where the resistance to the 
passing of the water is very much increased, the strength of the blad- 
der becomes proportionably greater. This happens principally in 
strictures of long standing. 

Such accidents are often observed before the outer end of the bou- 
gie has got beyond the projecting part of the penis, but even then it 
is difficult of extraction. I have succeeded in some of these cases 
by fixing the bougie in the urethra some way below its end; for in- 
stance, in the perinaeum, by pressing against it with one hand, and 
pushing back the penis upon the bougie with the other hand; then 
laying hold of the penis upon the bougie, removing the pressure be- 
low, and drawing the whole up; and by performing these two mo- 
tions alternately, I have been able to lay hold of the end of it. How- 
ever, this does not always succeed, for when the bougie is either 
small, or becomes soft, it will not admit of the penis being pushed 
down upon it without, bending; or if the thick end of the bougie has 
got beyond the moveable, or projecting part of the penis, then this 
mode of treatment becomes impracticable. I have succeeded in 
these last cases with the forceps for extracting the stone out of the 
urethra; but if it has got into the bend of the urethra, this pradice 
will also fail; and in such a state it would be most advisable to 
pass a catheter down to it, and cut upon that; and probably the 
above-mentioned forceps, introduced through the wound, might then 
lay hold of its end; or by cutting a little further, so as to expose some 
part of the bougie, it might be easily extracted, without the necessity 
of cutting into "the bladder. This part of the operation, however, 
would be very difficult in a fat or lusty man. 

To prevent the inconveniency of the bougie coming out, or the 



I2t) SUPPOSED CONSEQUENCES CHAP. II 

mischief of its passing in, it is necessary to tie a soft cotton thread 
round that end of the bougie which is out of the urethra, and then 
round the root of the glans. This last part should be very loose, lor 
an obvious reason; and the projecting part of the bougie should also 
be bent down upon the penis, which makes it both less troublesome 
and more secure. 



SECTION IV. 

Of the Application of a Caustic to Strictures. 

When a bougie can readily pass, there is no necessity for using 
any other method to remove the stricture; but there are too many 
cases where a bougie cannot be made to pass, or so seldom that it 
cannot be depended upon for a cure. This may arise from several 
causes. First, the stricture may be so tight as not to allow the 
smallest bougie to pass. Secondly, the orifice in the stricture may 
not be in a line with the urethra, which will make it uncertain, if not 
impossible, to pass a bougie. Thirdly, there may be no passage at 
all, it having been obliterated by disease, and the urine discharged 
by fistula: in perinaeo. 

The first very rarely occurs, for if the passage in the stricture be 
in a line with the general canal, a small bougie will commonly pass; 
and although it may not readily do so upon every trial, it will be suf- 
ficient to make way for another bougie, which is all that is wanted. 

The second case, where the canal is not in a line with the common 
passage, may arise from three causes. First, when the stricture is 
in the bend of the urethra, although the passage through it maybe in 
the centre of the canal, yet as the bougie cannot have the exact curve, 
it will be very uncertain in its application Secondly, from an irregu- 
larity in the formation of the stricture, which may throw the passage 
to one side, even in the straight part of the urethra; and thirdly, from 
ulceration having taken place, producing fistula? in perinaso, which 
often make the canal irregular in its course. 

The third case where the application of the caustic may be neces- 
sary is, where there is no passage at all, which happens from ulcera- 
tion and abscesses in the perinaeum opening externally; and in the 
healing of them the passage is often closed up entirely. In all the 
above-mentioned cases, I have succeeded with the caustic beyond ex- 
pectation. 

If the obstructions are any where between the membranous part of 
the urethra and the glans, where the canal is nearly straight, or can 
easily be made so by the introduction of a straight instrument, it be- 



UfcCT. IV. OF GONORRHOEA. 127 

comes an easy matter to destroy them by caustic; but if beyond that, 
it becomes then more difficult; however, at the beginning of the bend 
of the urethra, the obstruction may be so far removed as to admit of 
the passing of a bougie, or at least to procure a tolerably free passage 
for the urine. I have seen several cases where it was thought neces- 
sary to follow this practice, and it succeeded so well, that after a few 
touches with the caustic, the bougie could be passed, which is all that 
is wanted. The success in these cases was such as would incline 
me to have recourse to this practice very early; indeed, whenever I 
could not pass a small bougie through the stricture, I look upon the 
caustic as a much safer method than using pressure with a bougie, 
for the reason before mentioned, that is, on account of the danger of 
making a new passage, without destroying in the least any part of the 
obstruction. 

Most of the strictures which I ever examined after death appear- 
ed to have been in the power of such treatment; however, I have 
seen one or two cases, where the contraction was of some length and 
irregular, which would have puzzled me if I had attempted the cure 
with caustic; because I should have been apt to suspect that I was 
making a new passage by my gaining ground, and yet not relieving 
the patient by the removal of the symptoms. 

I have often tried this practice in strictures where there were also 
fistulas in the urethra, and where the water came through different 
passages. Such cases were not the most favourable; yet I succeed- 
ed in the greater part of them, that is, I overcame the stricLurc, and 
could pass a bougie freely. I have seen several cases of fistulas of 
these parts, where the natural passage was obliterated by the stric- 
ture, in which I have succeeded with the caustic, and the fistulous 
orifices have readily healed. 

It does not happen always in cases of obstruction to the passage of 
the urine, that when the obstruction is removed by the caustic, and 
the water of course passes freely, a bougie will also pass. This I 
apprehend arises from the caustic not having destroyed the stricture 
in a direct line with the urethra, so as to allow a bougie to catch the 
sound urethra beyond. But this appears to me of little consequence, 
as it is as much in the power of the bougie to prevent a return at this 
part as if it had passed on to the bladder; for if the water flows rea- 
dily, it is certain that the caustic has gone beyond the stricture, al- 
though it may not be in a direct line, and that the only risk of a re- 
turn of obstruction will be at the old stricture; but as a bougie can 
now pass beyond that part, it does as much good as if it passed into 
the bladder; for I have known several cases where the bougie ap- 
peared to have the same effect as if it had passed on to the bladder. 

The application of the caustic need not be longer than a minute, and 
it may be repeated every day, or every other day, allowing time for 
the slough to come off. But there are other causes that may prevent 
the repetition of the caustic, besides waiting for the separation of the 



128 SUPPOSED CONSEQUENCES CHAP. II. 

slough; for sometimes the use of it brings on irritation, inflammation, 
or spasm in the part, which frequently occasions a total suppression 
of urine for a time, against which all the means, used commonly on 
such occasions to procure relief, must be employed, and we must wait 
till these symptoms are gone off. If the patient can make water im- 
mediately after the application, it will be proper; as it will wash away 
any caustic that may have been dissolved in the passage, which if left 
would irritate the parts. A little water injected into the urethra will 
answer the same purpose. 

About the year 1752, I attended a chimney-sweeper labouring un- 
der a stricture. He was the first patient I ever had under this dis- 
ease. Not finding that I gained any advantage after six months trial 
with the bougie, I conceived that I might be able to destroy the stric- 
ture by escharotics;* and my first attempt was with red precipitate. 
I applied to the end of a bougie some salve, and then dipped it into 
red precipitate. This bougie I passed down to the stricture; but I 
found that it brought on considerable inflammation all along the in- 
side of the passage, which I attributed to the precipitate being rubbed 
off in passing the bougie. I then introduced a silver cannula down 
to the stricture, and through this cannula passed the bougie with pre- 
cipitate as before. Not finding, however, that the patient made wa- 
ter any better, and not as yet being able to pass the smallest bougie 
through the stricture, I suspected that the precipitate had not suffi- 
cient powers to destroy it. I therefore took a small piece of lunar 
caustic, and fastened it on the end of a wire with sealing wax, and 
introduced it through the cannula to the stricture. After having done 
this three times, at two days interval, I found that the man voided 
his urine much more freely. Upon the application of the caustic a 
fourth time, my cannula went through the stricture.! A bougie was 
afterwards passed for some little time till he was perfectly well. 

Having succeeded so well in this case, I was encouraged to apply 
my mind to the invention of some instrument better suited to the pur- 
pose than the before-mentioned, which I have in some degree effected, 
although it is not yet perfectly adapted to all the situations of stricture 
in the urethra. The caustic should be prevented from hurting any 
other part of the canal; which is best done by introducing it through 
a cannula to the stricture, making it protrude a little beyond the end 
of the cannula, by which it acts only upon the stricture. The caus- 
tic should be fixed in a small portcrayon. It is necessary to have a 
piece of silver of the length of the cannula, with a ring at one end, 
and a button at the other, of the same diameter with the cannula, form- 
ing a kind of plug, which should project beyond the end of the cannula 

* Having lately looked over some authors on this disease, I find that this is 
not a new idea. 

-j- Wiseman had the same idea, but probably the clumsy way in which he at- 
tempted to put it in execution might be the reason why he seems not to have 
pursued it. 



CHAP. III. OP GONORRHCEA. 129 

that enters the urethra, by which means it makes a rounded end; 
or the portcrayon may be formed with this button at the other end. 
The button being introduced into the cannula, it should be passed in- 
to the urethra; and when it reaches the stricture, the silver plug 
should be withdrawn, and the portcrayon with the caustic introduced 
in its place; or, if the plug and portcrayon are on the same instru- 
ment, then it is only withdrawing the plug, and introducing the port- 
crayon with the caustic. This plug, besides giving a smooth round- 
ed end to the cannula, answers another good purpose, by preventing 
the cannula from being filled with the mucus of the urethra, as it passes 
along, which mucus would be collected in the end of it, dissolve the 
caustic too soon, and hinder its application to the stricture.* 

If the stricture be in the bend of the urethra, the cannula may be 
bent at the end also; but it becomes more difficult to introduce a 
piece of caustic through such a cannula, for the plug and portcrayon 
must also be bent at the end, which cannot be made to pass through 
the straight part of the cannula; but this I have in some measure ob- 
viated, by having the cannula made flexible, except at the end where 
it is to take the curve.f 

After the bougie can be made to pass, the case is to be treated as 
a common stricture, either by dilating it slowly, or by quickly increas- 
ing the size of the bougie, and thus continuing the ulceration. 

There are sometimes more strictures than one; but it seldom hap- 
pens that they are all equally strong. One only becomes the object 
of our attentiou. The smaller ones may, however, be sufficient to 
hinder the passing the cannula to that which is to be destroyed by 
the caustic. When that is the case, those small strictures are to be 
dilated with bougies, as in common, till they are sufficiently large to 
allow the cannula to pass. 



CHAP. III. 

Of Strictures in Women. 



Obstructions to the urine in women, I believe, generally arise 
from stricture, although not always; for I have known them produc- 
ed by compression from some adjacent swelling; and they are com- 
mon in uterogestation, as also in dropsical or scirrhous ovaria. But 
such causes are commonly known long before this effect is produced, 
by which the suppression is easily accounted for. It may also arise 
from excrescences as in men. 

Vide plate III, fig. 1 • t Vide plate UT, fig. 2 and 3. 



1 30 SUPPOSED CONSEQUENCES CHAP. III. 

How far a stricture, in the urethra of this sex, is really a conse- 
sequence of a venereal inflammation, I am not certain; but 1 should 
suppose it is not; and for stronger reasons still than those which I 
gave in speaking of the cause of strictures in men; lor 1 can say, 
that none of the strictures that I have seen in women have arisen ;n 
consequence of this disease; at least I had no reason to believe that 
they did; and I have observed before, that in most women who have 
the venereal disease in the form of a gonorrhoea, it seldom attacks the 
urethra. Therefore, if we find a stricture in a woman who has had 
the disease, we are not to impute it to that, at least till we can as- 
certain the urethra was affected; and even then it will remain 

doubtful. . _,, . 

Si-iclures are not near so common in women as in men. lnis 
may be owing to the great difference in the length of the two canals; 
but more especially to the canal in women being more simple, 
and intended only for one purpose. The stricture in women does not 
produce such a variety of symptoms, or so much mischief, as in 
men, there not being so many parts to be affected. 



SECTION I. 

Of the Cure of Strictures in Women. 

The cure of strictures in the urethra of women is similar to that in 
men; but it is rather more simple from the simplicity of the parts. 
There is, however, an inconvenience attending the passing the bougie 
in women, that does not occur in men, which is, that in most cases it 
must be passed for them, it being hardly possible for a woman to in- 
troduce a bougie herself. The confinement of the bougie is also 
more difficult; for although it can easily be prevented from going in- 
to the bladder by bending the outer end down upon the mouth of the 
vagina, yet it is very difficult to prevent it from slipping out. It will 
be necessary to have a bandage of the T kind passing down between 
the labia over the bend of the bougie. 

It appears to me that the caustic would answer extremely well in 
such cases; and therefore I should prefer it to the bougie, both for 
convenience and efficacy. 



SECT. II. OF GONORRH(EA. J31 

SECTION II. 

Of the Gleet in consequence of a Stricture. 

I have already observed, that it happens generally, if not always 5 
that there is a gleet when there is a stricture in the urethra. This I 
suppose to arise from the irritation produced in the urethra beyond 
the stricture, by the urine in its passage distending this part too much 
which distention is increased by the increased strength of the bladder. 
This symptom often leads us to the knowledge of a stricture, or at 
least gives a suspicion of such a disease; and when a stricture is 
known to be the cause, no attempts should be made to cure the 
j,lcct, for it is generally cured when the stricture is removed; but 
if it still remains, it may be cured in the manner recommended in 
the common gleet, as probably arising from a cause different from 
stricture. 



CHAP. IV. 



Of Stricture attended with Spasmodic .Affection. 

There are very few strictures that are not more or less attended 
with spasms; but some much more than others, the spasm being in 
some cases more the disease than the stricture itself. But real stric- 
tures are attended with occasional contractions, which make 
the passing of the urine much more difficult at one time than an- 
other. In all the cases that I have seen of this kind, when not 
attended with spasms, the disease is not formidable; but when the 
parts are in a spasmodic state, the symptoms are as violent as in 
the simple stricture. 

As this is a mixed case, it has all the characters both of the perma- 
nent and spasmodic stricture; for the urethra in such circumstances 
is in a state similar to what it is in the true spasmodic kind, being very 
irritable, giving great pain in the passing of the bougie, and often re^ 
jecting it altogether, as will be taken notice of when we shall treat of 
that disease. 

Upon considering this subject we should at first hardly be disposed 
to believe that the spasm in the urethra is in the strictured part, which 
van scarcely be supposed capable of contraction; and it might there 
fore naturally be referred to the sound part of the urethra, as being 
brought on by the waters not flowing freely. If this is a just mode 



132 SUPPOSED CONSEQUENCES CHAP. IV. 

of accounting for it, we must suppose that the contraction is behind 
the stricture, that being the only part dilated by the water; and such 
urethras being very irritable, that part may contract so as to stop the 
flowing of the water altogether. But some circumstances that occur 
in practice give reason to believe that such strictures have the power 
of contraction; for we find the bougie grasped by the stricture when 
allowed to remain some time; and the circumstance of the strictured 
parts refusing the bougie, at times, is also a proof of the same. 

There is sometimes this singular circumstance attending these 
cases, that when there arises a gonorrhoea, or any other discharge of 
matter from the urethra, or an increase of the old gleet, the passage 
becomes free, and allows the urine to pass as usual; but such relief 
is uncertain and only temporary; for, whenever the discharge ceases, 
the spasmodic affection returns. I think it is probable that it is only 
the spasm that is affected by the discbarge, and not the real stricture. 
Two remarkable cases of this kind fell under my observation, which 
I shall now relate. 

A gentleman had for a long time a complaint in the urethra, at- 
tended with a stricture, which was supposed to be originally from a 
venereal complaint. It was often attended with a discharge, which 
always produced a slight fever on its coming on; but while the dis- 
charge lasted the difficulty of making water was relieved, and that in 
proportion to the greatness of the discharge; and whenever he got a 
fresh gonorrhoea the same thing happened. 

Another gentleman had a difficulty of making water, supposed to 
arise from a stricture. It was generally attended with such a run- 
ning as is common to strictures; but when that discharge was much 
increased, then the stricture was less in proportion. During this 
complaint he contracted two different infections, both of which re- 
lieved him of the stricture for the time. 

As this is a mixed disease, it may be thought proper to treat it 
with a bougie for the real stricture, and for the other to use the me- 
thod to be recommended hereafter, for the cure of spasm. 

It sometimes happens in these mixed kinds, that a bougie does not 
immediately pass, but is rejected by the spasm; but, by letting it lie 
in the urethra, almost close to the stricture, for ten, fifteen, or twenty 
minutes, you will often make it pass. This is, as it were, stealing 
upon it, and the water will often flow, although the bougie is not 
attempted to be passed on. It is often relieved by gently irritating 
injections. 



CHAP. V. OF GONORRHCEA. 133 



CHAP. V 



Of some Circumstances attending the Use of Bougks — their Figure 
and Composition. 

In cases of strictures, where a bougie is used as a wedge, not as 
a stimulant, and where a stricture is so far overcome as to let a 
bougie pass on, the question is, whether it may be better to pass the 
bougie through the whole length or the urethra, so that the end of it 
shall be in the bladder, or only to pass it through the stricture a lit* 
tie way, so that its end shall remain in the urethra. Nothing but ex- 
perience can determine this question; and, perhaps, in such cases 
we seldom make a fair trial, generally pushing the bougie on to the 
bladder; though, if we observe the consequences of bougies not pass- 
ing in those cases where they either cannot pass far beyond the 
stricture, or not at all, we find no inconvenience arising from this 
circumstance, except when they are applied with too much force, so 
as to make a new passage. The common idea is, that it will be 
more hurtful to allow the end of the bougie to lie in the urethra than 
in the bladder; but this seems to be more founded in theory than 
practice. 

Some people have such a quantity of calculous matter in their 
urine, or so great a disposition in their urine to deposit its calculous 
matter, that it only requires the presence of an extraneous body in 
the bladder to become an immediate cause of stone; for I have ob- 
served in some, that the end of a bougie cannot remain in the blad- 
der a few hours without being covered with a crust of calculous mat- 
ter. Such people I have generally advised to use as much exercise 
as all other circumstances will allow. 

Bougies, when first introduced, often produce sickness, and some- 
times even fainting. I have seen a patient become sick, the colour 
leave his face, a cold sweat come on, and at last a deliquium; but 
all these effects soon go off, and seldom return upon a second or third 
trial. They at first produce an irritation on the urethra, which gives 
pain in the time of making water, but goes off on repetition. They 
produce a secretion of pus in those cases where there was none, and 
generally increase the discharge where there is one previous to the 
application of them; but this effect gradually ceases. 

It frequently happens, that swellings in the lymphatic glands of 
the groin arise from the use of bougies; but I never saw them ad- 
\ nice to suppuration. As in most of such cases there is a discharge 
of matter previous to the bougie being passed, they can hardly be 
owing to the absorption of matter, but must arise from sympathy 



134 SUPPOSED CONSEQUENCES CHAP. V. 

When treating of the stricture, I observed that it was often the 
cause of a swelling in one or both testicles; and further, that the 
passing of a bougie often removed that complaint. I may now ob- 
serve, that a very common consequence of the passing a bougie is a 
swelling of the testicle. This also arises from sympathy, and, like 
the swelling of the glands, is a common effect of all irritations of the 
urethra. 

It may not be improper here to add some observations on the figure 
and composition of bougies. They ought to be about two inches 
longer than the distance between the glans and the stricture, or more 
if they can pass freely, so as always to allow an inch to bend upon 
the glans, and another to pass Jaeyond the stricture. The thick- 
ness should be according to the size of the stricture; at first, such as 
will pass with a small degree of tightness, and this should be gradu- 
ally increased as the contracted part enlarges. But when the urethra 
has become of the natural size, the bougie need not be further in- 
creased, but its use still continued, as has been observed. 

With regard to the shape, they should not taper from end to end 
when very small, but should be nearly of an equal thickness till 
within an inch of their smallest end, after which they should taper 
to a point, forming a round wedge fitted to pass into the stricture; 
and this form gives them greater strength than when made to taper 
from one end to the other. 

The consistence ought to vary according to the nature of the case, 
and size of the bougie. If the stricture be near the glans, a stiff 
bougie may be used, and the whole may be made to taper gradually, 
because a short bougie will always have sufficient strength for any 
pressure that is necessary; but if the stricture be more deeply seated, 
as about the bulb, where the passage begins to take a curve, the 
bougie must be a little thicker in its body to support the necessary 
pressure. If the stricture be any where in the bend of the urethra, 
or near the bladder, the bougie should be very flexible, (although 
this is contrary to our general position,) because in this case it must 
bend in order to adapt itself to the curve of the passage, which it 
ought to do with ease; for when it bends with difficulty it does not 
make its pressure upon the stricture, but upon the back part of the 
urethra, and therefore does not enter so easily; which circumstance 
makes it more difficult to enter a stricture near the bladder than near 
the glans. In the composition of the bougie the consistence is the 
most material thing to be considered; the medical properties, as far 
as known, being of little consequence. The materials of which they 
are commonly made are, wax, oil, and litharge. The litharge gives 
them smoothness, and takes off the adhesive quality which they 
would have if made of wax and oil only. A composition which an- 
swers well is, three pints of oil of olives, one pound of bees wax, and 
a pound and a half of red lead, boiled together upon a slow fire for 
six hours. 



SECT. I. OP GONORRHOEA. 135 

SECTION I. 

Of a rww Passage formed by Bougies. 

The greatest evil arising from the improper use of the bougie, and 
the most dangerous, is, where it makes a new passage.* I have men- 
tioned before that this generally arose from an attempt to produce 
ulceration by the application of the end of the bougie to the stricture 
in cases where a bougie could not pass; for in those cases where a 
bougie passes, there can be no danger of such an effect. 

This new passage is seldom carried so far as to produce either an 
increase of the present disease, or a new one, although sometimes this 
happens; yet it prevents the cure of the original disease, for it renders 
both the application of the bougie and caustic to the stricture so un- 
certain, that a continuance of either is dangerous, as it may increase 
the mischief, and at last produce very bad consequences. 

This new passage is generally along the side of the old one, when 
in that part of the urethra which is on this side of the bend, and it is 
made in the spongy substance of the urethra; but when it is made at 
the beginning of the bend, it passes on in a straight line through the 
body of the urethra, about the beginning of the membranous part, and 
goes through the cellular substance of the perinaeum towards the rec- 
tum. When the new passage is made between the glans and the 
bend of the urethra, it may take place on either side of the canal 
equally, in the spongy substance of the urethra, between the canal 
and the skin of the penis, or scrotum; and it may be between the 
canal and the body of the penis. The situalion of it will make 
some difference in the operation necessary for the cure of this com- 
plaint. 

When a new passage is made, I know of no other method of cure 
than to open the part externally; and the opening must be made in 
that part of the urethra which is most convenient for coming at the 
stricture; regard being had to the other external parts, such as the 
scrotum. If the stricture be before the scrotum, the new passage 
will be there also, and therefore the operation must be made of course 
before that part; but if the stricture is opposite to the scrotum, the 
bottom of the new passage may also be opposite to this part; but if 
the new passage is of a considerable length, its bottom or termina- 
tion may be in the beginning of the perinaeum; and in either situation, 
the operation must be begun behind the scrotum, or indeed may be 
made a little way into it. But if the stricture and new passage are in 
the perinaeum, then the operation is to be performed there. 

The method of performing tins operation is as follows: Pass a staff. 

• Vide plate IL 



136 SUPPOSED CONSEQUENCES CHAP - y ' 

or any such instrument, into the urethra as far as it will go, which 
will probably be to the bottom of the new passage; and that, we may 
be certain, is beyond the stricture. Feel for the end of the instru- 
ment externally, and cut upon it, making the wound about an inch 
long, if the disease be before the scrotum; and an inch and a hal , or 
more, if in the perinaeum. If the new passage be between the urethra 
and tne body of the penis, then you will most probably get into the 
sound urethra before you come to the instrument or new passage; it 
so, it is not necessary to go further in order to get into the bladder, as 
we maybe certain that this part of the urethra is behind the stric- 
ture. Having proceeded so far, take a probe, or some such instru- 
ment, and introduce it into the urethra by the wound, and pass it 
towards the glans, which will be passing it forwards towards the 
stricture. If it meet with an obstruction there, we may be certain 
it is the stricture, which is now to be got through, and which will 
afterwards be easily enlarged. To complete the operation, with- 
draw the probe, and introduce, in the room of it, a hollow cannula 
forwards to the stricture; then take another cannula, and introduce 
it from the glans downwards, till the two cannulas oppose each other, 
having the stricture between them; an assistant laying hold of the 
urethra on the outside, between the finger and thumb, just where 
the two cannulas meet, to keep them in their places; then through 
the upper cannula introduce a piercer, which will go through the 
stricture, and pass into the lower cannula; this done, withdraw the 
piercer, and introduce a bougie into the same cannula, in the same 
way, being careful that it passed into the lower cannula: then with- 
draw the lower cannula, and the end of the bougie will appear in the 
wound; lay hold of the bougie there, and withdraw the upper can- 
nula over the bougie, leaving the bougie in the urethra; now the 
lower end of the bougie is to be directed into the urethra, leading on 
to the bladder, and pushed on to that viscus. It may be further ne- 
cessary to lay the whole of the new passage open, that it may all 
heal up; for it is possible that this new passage may often receive 
the bougie, to be applied in future, which would be troublesome, 
and might prove an obstruction to the cure. 

If the new passage be between the skin and the canal of the ure- 
thra, after cutting down to the instrument, you must go further on in 
search of the natural canal, and, when you have found it, introduce 
a probe into it towards the glans, to find the stricture; and when this 
is done, go on with the operation as above described. 

The bougie must be left in the passage, and as it may be found 
difficult afterwards to introduce another readily into the bladder, the 
longer the first is allowed to remain, so much the more readily will 
the second pass. I am not yet certain but that it would be better to 
push on the hollow cannula at first, and keep it there for some days, 
at least till the inflammation is over, and the parts have adapted 
themselves to that body, which will make a bougie pass more easily 



SECT. I. OF GONORRHCGA. 137 

afterwards. The bougies must be gradually increased in size, and 
continued till the wound is healed up. 

The first case of a new passage, formed by a bougie, which I ever 
saw, was at the hospital of the third regiment of guards, about the 
year 1765. A young soldier had a stricture, for the cure of which 
he had bougies regularly passed for near half a year without any 
relief. The bougie had gone further than at first by two inches, 
and therefore seemed to have gained ground on the stricture. This 
seemed to justify the continuance of the practice; but it being sus- 
pected that there was something more than was then understood, I 
was consulted, and without foreseeing what was really the case, I 
proposed that an opening should be made into the urethra where the 
obstruction was, and carried further back if necessary, in search of 
the sound urethra. This was accordingly done in the following 
manner: the grooved staff was first passed as far down as it could 
go, which was to the bottom of the new passage; the scrotum was 
pulled up upon the penis, when the end of the staff was prominent 
towards the skin a little way above the perinaeum, and there an inci- 
sion was made on the end of the staff about half an inch long; this 
disengaged the end of the staff, which was pushed out at the wound; 
then search was made for the other orifice which led to the bladder, 
on a supposition that that orifice was the stricture; but none being 
to be found, we tried to trace it by blowing with a blowpipe into 
the bottom and lower part of the wound; but no orifice could be ob- 
served. We then began to suspect that we were not in the urethra. 
To determine if we had been in the urethra, I began to dissect with 
tare the parts at the bottom of the wound, and laid bare the musculi 
acceleratores. I then made an incision into the body of the urethra, 
and came to the true canal, which was easily discovered. When 
this was done we passed a probe on to the bladder; then withdrew; 
turned, and passed it from this wound towards the glans penis, but 
found that it went not much more than two inches that way, and then 
stopped. This struck us with a new idea of the case; for we were 
now sure that the end of the staffhad not been in the urethra, but in a 
new passage made in the spongy part of the urethra, for two inches 
beyond the stricture. We now passed a staff from the glans down 
the urethra, and another up from the last wound, to see at what dis- 
tance the ends of the two instruments were, which would give us 
the length of the stricture. We found, by taking hold of the urethra 
between the finger and thumb on the outside, that the two ends were 
close together; What was to be done next was our consideration: 
it immediately struck us that we might force our way through the 
stricture with* safety. The gentleman who assisted me in the ope- 
ration passed a blowpipe one-fifth of an inch in diameter, (being not 
sufficiently furnished with instruments,) from the wound forwards to 
the stricture; and then I took a silver cannula, open at both ends, 



138 SUPPOSED CONSEQUENCES CHAP. V. 

which had an iron piercer longer than itself, and passed it down to 
the stricture from the glans; and now the end of the cannula opposed 
the end of the blowpipe, and they were almost close upon one ano- 
ther. They were kept in this position, with the finger and thumb 
applied on "the outside of the penis, like splints on a broken bone. 
I then introduced the piercer, and pushed it on, which went through 
the stricture into the hollow of the blowpipe. Great care was taken 
not to push too forcibly, lest the two ends of the hollow tubes should 
slip by one another, which they would do if not held firmly, as ac- 
tually happened twice in this case; but we succeeded the third .time* 
I then pushed on the cannula through the stricture, and with it 
pushed out the blowpipe. The next object was to pass a hollow 
bougie along the urethra to the bladder, to do which the small end 
of it was introduced into the cannula, which, being pushed on, forced 
out the cannula at the wound; we then passed a director into the 
other orifice of the urethra, leading on to the bladder, and put the 
end of the bougie into the groove of the director, and pushed it along 
the groove to the bladder; and before we withdrew the director, we 
turned it round with its back to the bougie, that the end of the bougie 
might not stop against the end of the groove, and so be pulled out 
again. After all this was done, one stitch was made in the urethra, 
but the external wound in the skin was left for the passage of the 
urine, that it might not insinuate itself into the cellular membrane. 
We dressed the wound superficially, and applied the T bandage, 
which was slit to go on each side of the scrotum, and just where it 
came to the scrotum we tied the two ends together, which supported 
the scrotum and kept it forwards on the .penis; and the two ends that 
came from this knot on each side of the scrotum were tied to the 
circular part that came round the body. The patient had some 
slight fever for a day or two, and the urine came partly through the 
bougie, and partly by the side of it through the wound. A swelling 
of one testicle came on, likewise a swelling of the glands of the 
groin, pain in the belly, sickness, and at times vomiting, all which 
symptoms were owing to sympathy, and entirely went off in five or 
six days. The w r ater, in nearly the same time, came entirely by the 
natural passage. The bougie was changed from time to time till the 
cure was completed 



SECT! OF GONORRHffiA. 139 



CHAP. VI. 

Of Diseases in consequence of a permanent Stricture in the 

Urethra. 

Strictures in the urethra produce almost constantly diseases in 
the parts beyond them; that is, in the part of the urethra between 
the stricture and the bladder. They bring on in most cases a gleet, 
as has been described, and often a considerable distention of the part 
of the canal beyond the stricture; also inflammation and ulceration, 
and in consequence of them diseases in the surrounding parts, as in 
Cowper's glands, the prostate, and the surrounding cellular mem- 
brane, forming abscesses there, and at last ulceration, for the pur- 
pose of making a new passage for the urine. The bladder is also 
often affected, and sometimes the ureters, with the pelvis of the 
kidneys, and in some cases the kidneys themselves. All these are 
effects of every permanent obstruction to the urine; some of them 
are methods which nature takes to relieve the parts from the imme- 
diate complaints; such are the increase of the urethra beyond the 
stricture, and the enlargement of the ureters and pelvis of the kid- 
neys, which are only to be considered as the parts accommodating 
themselves to the immediate consequence of the obstruction, which 
is the accumulation of urine. Of these complaints I shall take notice 
in their order 



SECTION I. 

Of the Enlargement of tlve Urethra. 

The urethra beyond the stricture I have observed is enlarged, 
because it is more passive than the bladder, and yie ds to the pres- 
sure of the urine. It is naturally passive while the bladder is act- 
ing, by which means it becomes distended in proportion to the force 
will, which the bladder acts, and the resistance of the stne ure Is 
internal surface often becomes more irregular and fasciculated It 
is also more irritable, the distention becoming often the immediate 
cause of spasms in that part; ^d these spasms are most probably 
excited with a view to counteract the efforts produced by the action 
of the bladder. 



140 SUPPOSED CONSEQUENCES CHAP.. VI. 

SECTION II. 

Of the Formation of a New Passage for the Urine. 

When the methods recommended above for the removal of stric- 
tures have either not been attempted, or have not succeeded, Nature 
endeavours to relieve herself by making a new passage for the urine, 
which, although it often prevents immediate death, yet, if not reme- 
died, is productive of much inconvenience and misery to the patient 
through life. The mode by which Nature endeavours to procure 
relief is by ulceration on the inside of that part of the urethra, which 
is enlarged and within the stricture. The ulceration commonly 
begins near or close to the stricture, although the stricture may be 
at a considerable distance from the bladder; therefore we must sup- 
pose, that there is some circumstance besides the distention of the 
urethra by the urine, which determines the ulceration to a particular 
part. This circumstance most probably arises immediately out of its 
vicinity to the stricture, and may be called contiguous sympathy. 
The stricture is often included in the ulceration, by which it is re- 
moved, the disease cured, and a stop sometimes put to the further 
ulceration; but unluckily this is not always the case. We may ob- 
serve, that this ulceration is always on the side next to the external 
surface, as is common in abscesses. 

As this ulceration does not arise from preceding inflammation; 
and as it cannot be said that the urine acts exactly as an extraneous 
body, because it is in its natural passage, we find that there is but 
very little inflammation of the adhesive kind attending these ulcera- 
tions. We must allow, however, that the urine produces the ulcer- 
ative disposition here, like matter on the inside of an abscess, al- 
though not so readily. 

Whenever, therefore, the internal membrane and substance of the 
urethra are removed by absorption, the water readily gets into the 
loose cellular membrane of the scrotum and penis, and diffuses itself 
all over those parts, not having been previously united by the adhe- 
sive inflammation; and as the urine has considerable irritating 
powers, when applied to the common cellular membrane, the parts 
inflame and swell. The presence of the urine prevents the adhesive 
inflammation from taking place; it becomes the cause of suppuration 
wherever it is diffused; and the irritation is often so great, more espe- 
cially in cases where the urine has been allowed to become very 
stale, that it produces mortification first in all the cellular membrane, 
and afterwards in several parts of the skin; all of which, if the patient 
live, slough away, making a free communication between the urethra 
and external surface, aa I produce fistulae in perinaeo. 

We may observe, however, that the want of the adhesive inflam- 



SECT. II. OF GONORRHOEA. 141 

mation in these ulcerations appears to be peculiar to that part of the 
urethra which lies between the membranous part and the glans penis; 
for we find, from experience, that when this process takes place fur- 
ther back, as in the prostate gland, a circumscribed abscess is gene- 
rally formed. This may arise from the difference in texture of the 
cellular membrane of the parts, the first admitting of the diffusion of 
the urine very readily from the looseness of its texture, the other 
producing adhesions before the urine is allowed to pass; which ad- 
hesions afterwards exclude it. 

It sometimes happens, that the urine gets into the spongy substance 
of the body of the urethra, and is immediately diffused through the 
whole, even to the glans penis, producing mortification of all those 
parts, as I have more than once seen. 

When the urine has made its way into the cellular membrane, al- 
though the ulceration of the urethra is in the perineum, yet it gene- 
rally passes easily forwards into the scrotum, that part being com- 
posed of the loosest cellular membrane in the body. When the seat 
of the ulceration is in the membranous or bulbous part of the ure- 
thra, and the pus and urine have found their way to the scrotum, 
there is always a hardness extended along the perinaeum to the 
swelled scrotum, which is in the tract of the pus. 

Ulceration cannot be prevented but by destroying the stricture; but 
when the water is in the cellular membrane, which is the state we 
have been describing, the removal of the stricture will in general be 
too late to prevent all the mischief, although it will be necessary for 
the complete cure: therefore an attempt should be made to pass a 
bougie, for perhaps the stricture may be included in the ulceration, 
(as was mentioned before,) and thereby allow a bougie to pass. 
When this is the case, bougies must be almost constantly used to 
procure as free a passage forwards in the right way as possible. 
Where the bougie will not pass, I am afraid that the caustic, as de- 
scribed in the case of a stricture, would in many cases be too slow in 
its operation, and in others it cannot be tried, as the situation of the 
stricture is often such as will not admit of it. 

While we are attempting the cure of the stricture, every method 
is to be used that removes inflammation, particularly bleeding. Great 
relief may be obtained by exposing the parts to the steam of hot wa- 
ter; but this is merely a palliative cure. The warm bath, opium, 
and the turpentines, given by the mouth, and also by the anus, will 
assist in taking off any spasmodic affection; but all these are too 
often insufficient, and therefore immediate relief must be attempted, 
both to unload the bladder, and prevent any further effusion of urine 
into the cellular membrane. This must be done by an operation, 
which consists in making an opening into the urethra somewhere be- 
yond the stricture, and the nearer to the stricture the better. 

The method of performing the operation is, first to pass a director 
•r some such instrument into the urethra, as far as the stricture; then 



142 SUPPOSED CONSEQUENCES CHAP. ft. 

to make the end of the instrument as prominent externally as possi- 
ble, so as to be felt, which in such a case is often difficult, and some- 
times impossible. If it can be felt, it must be cut upon, and the in- 
cision carried on a little further towards the bladder, or anus, so as 
to open the urethra beyond the stricture; this will be sufficient to al- 
low the urine to escape, and to destroy the stricture. If the instru- 
ment cannot be felt at first by the finger, we must cut down toward! 
it, which will bring it within the feel of the finger, and afterwards 
proceed as above directed. 

If the stricture in the urethra be opposite to the scrotum, it being 
impossible to make the opening there, it must be made in the peri- 
naeum, in which case there can be no direction given by an instru- 
ment, as one cannot be made to pass so far; therefore we must be 
guided by our knowledge of the parts. The opening being made, the 
stricture is to be searched for as described in the operation, in cases 
where a false passage has been made, by passing a probe from the 
wound forwards towards the glans. The other steps of the opera- 
tion will be nearly the same. In whichsoever way the operation is 
performed, a bougie must be introduced, and the wound healed up 
over it. In my opinion a catheter answers this purpose better. 

Great attention should be still paid to the inflammation which 
arises in consequence of the urine having been diffused in the cellu- 
lar membrane, as before described. Where the inflammation is at- 
tended with suppuration and mortification, it will be necessary, as 
well in this case as in that where no operation is required, to scarify 
the parts freely, to give an opening both to the urine and pus. Where 
mortification has taken place in the skin, the scarifications should be 
made in the mortified parts, if it can be done with equal advantage, 
and this with a view to prevent irritation. 

In total suppressions of urine, from whatever cause, the urine 
should never be allowed to accumulate, and should either be drawn 
off frequently, or a catheter should be kept continually in the ure- 
thra and bladder; because we should on no account allow the blad- 
der to be distended beyond an easy state; for if it be, it always brings 
on debilitating and alarming symptoms, as paralysis of that viscus. 
In many suppressions of urine, as in cases of strictures, it is impos- 
sible to draw off the water. In some cases where the urethra is ul- 
cerated, and the urine gets into the cellular membrane of the. penis, 
and prepuce, so as to distend them much, producing a phymosis, it 
becomes impossible to find the orifice of the urethra. The following 
case illustrates most of the preceding doctrines. 

A gentleman of a scrofulous habit had often had venereal gonor- 
rhoeas, which, being severe, commonly produced swellings, or knobs, 
along the urethra; upon which account he was advised to avoid this 
disease as much as possible. When in the country, in November, 
1782, he was attacked with a slight cold or fever, 'and a small dis- 
charge from the urethra, which he could not determine to be vene- 



SECT. II. OP GONORRHOEA. 113 

real. In this state he set out for London, but was seized on the road 
with a suppression of urine, which detained him two days at an inn. 
On his arrival in London, I found him feverish. He spoke to me 
only of a discharge from the urethra; but as I did not conceive that 
the fever could arise from that cause, I desired him to be easy on 
that account. He was taken with a shivering fit, which made u£ 
suspect it might terminate in an intermittent, and we waited for 
the result. He still complained of the discharge, and mentioned a 
soreness in the perinaeum, both when he made water and when he 
pressed it externally. On examining the perinaeum, I found a fulness 
there, from which I suspected a stricture, and inquired particularly 
how he made water in common; he declared very well, which led 
me from the true cause. This swelling was regarded as the effect 
of an inflammation, either in consequence of the fever, the disposi- 
tion of the part, or both, increased by sitting in a post-chaise for se- 
veral days. The part was fomented and poulticed; and leeches were 
applied several times. He had another shivering fit three days after 
the first, which, if his disease had been an intermittent, would have 
constituted a quartan; but he had another some hours after, which 
made us give up our suspicions of an intermittent. We now began 
to suspect that matter was forming in this part, although I could not 
feel any thing like a fluctuation; nor was the pain of the throbbing 
kind, or so acute as we commonly find it in the suppurative inflam- 
mation. What in some degree surprised me was, that the swelling 
came forwards along the body of the penis towards^he os pubis, 
while it seemed to be diminishing in the perinaeum. He now began 
to find a difficulty in making water, with a frequent desire, which inr 
creased till there was a total suppression. I pressed on the lower 
part of the belly, to determine whether or not the urine was secreted 
and accumulated in the bladder; but I could not find any fulness; 
nor did he then feel pain, on such pressure; however, about twenty- 
four hours after, he began to complain of a great desire to make wa- 
ter, and a pain in the lower part of his belly; and the hand being 
placed there, a fulness of the bladder was readily felt. It was now 
clear that the water ought to be drawn off; but, as I still suspected 
mischief in the urethra as a cause in his complaint, I took the ne- 
cessary precautions. I provided myself with catheters and bou- 
gies of different sizes, and to be as much upon my guard as possible, 
I introduced a bougie of a small size first, and found a full stop about 
the bulbous part of the urethra: I then took a smaller, which passed, 
but with difficulty. I afterwards passed a small catheter on to the 
stricture, where it stopped; but as it was absolutely necessary that 
the water should be drawn off, I used more force than I otherwise 
would have done: it went on, but with difficulty, and I was not cer- 
tain whether it was in the natural passage, or was making a new 
one. When the bougie had gone so far as certainly (if in the right 
passage) to have entered the bladder. I found that no water came; I 



144 SUPPOSED CONSEQUENCES CHAP. VI. 

therefore pressed the lower part of the belly, and the water imme- 
diately came out through the catheter; whence it appeared that the 
bladder had lost its power of contraction. The water was drawn 
off three times every day, that is, every eight hours, to give as much 
ease to the bladder as possible; but still it was necessary to press 
the belly, to assist the discharge of the urine; and it was upwards of 
a fortnight before the bladder began to recover its power of contract- 
ing. The swelling in the perinaeum still continued, advancing along 
the body of the penis, and spreading a little on the pubes, it seemed 
to extend along the projecting part of the penis, and at last filled the 
whole cellular membrane of the prepuce, but did not in the least af- 
fect the scrotum. This swelling appeared to be owing to the urine 
having found its way into the cellular membrane of the perinaeum, 
and from thence proceeding along the side of the penis. When the 
prepuce became much loaded with water, a very considerable phy- 
mosis took place, which made the introduction of the catheter into 
the orifice of the urethra very uncertain; so much did the swelled 
prepuce project over the glans. I was obliged to squeeze the water 
back into the body of the penis, and introduce a ringer, and feel for 
the glans, and on this finger introduce the catheter; and in a few 
minutes I generally found the orifice. 

The nature of the case was now plain; for ulceration had taken 
place beyond the stricture, and the swelling had arisen from the 
urine having insinuated itself into the cellular membrane of the peri- 
naeum; and as the urine escaped from the urethra, it was pushed 
forwards where the cellular membrane was loosest, till it got to the 
very end of the prepuce as before mentioned. 

By this time he was become extremely low and irritable; his pulse 
quick and small; his tongue brown, dry, and contracted; his appe- 
tite gone, with great drought, bad sleep, and the first stages of a de- 
lirium coming on. This discovery of the true state of the case gave 
a change to the mode of treatment. Instead of evacuations to les- 
sen inflammation, the bark and cordials were given, with as much 
food as his stomach would bear. Their effects on the constitution 
were almost immediate, and he began to recover, although but 
slowly. I made two punctures in the phymosis at the extremity, with 
a view both to take off the tension and to evacuate the urine from 
the cellular membrane, between the penis and the skin. 

Blisters began to form on the skin of the penis; and at last morti- 
fication took place in several parts, especially on the prepuce, which 
I divided at the mortified parts, and thereby the glans became ex- 
posed, so that the catheter could now be introduced easily. 

Upon squeezing the swelling from the perinaeum forwards along 
the penis, I could force out, at the mortified parts, air, water, and 
some matter. The cellular membrane under the skin was almost 
wholly mortified. When bounds were set to the mortification, the 
sloughing cellular membrane began to separate; and a good deal was 



SECT. III. OF GONORRHOEA. 145 

cut away to keep the parts clean, and to allow of a freer vent for the 
matter. Now that separation was taking place, I was clear that no 
more water from the bladder could insinuate itself any further into 
the surrounding cellular membrane; therefore it was not necessary to 
pass the catheter any more; and the patient was allowed to make wa- 
ter whenever he had a call; which when he did, the water came 
both ways, tlwough the urethra, and through the cellular membrane, 
at the openings where the skin had sloughed off. As the sloughs se- 
parated, they came forwards from behind, at the side of the scrotum, 
so that I could draw them out; and when most of the mortified cel- 
lular membrane was removed, I saw a part, about the size of a six- 
pence, of the tendinous covering of the corpus cavernosum dead, 
which was also allowed to slough off. Most of the water now came 
through the sore. The parts became more painful; he was more 
restless, and one morning he had a shivering fit. I endeavoured to 
pass a bougie down the sore, between the skin and penis, but could 
not; in the evening of the same day, a gush of matter and blood 
came out of the sore, which immediately relieved him, and he began 
to mend again, and continued to do so, both in the parts and his gene- 
ral health, the water coming both ways, but often varying in quan- 
tity between the two passages; more and more, however, came the 
right way, till at last the new passage closed up entirely. 

While the external parts were healing, I passed a bougie occa- 
sionally, to keep the passage clear and open. To find out the situa- 
tion of the internal opening, I ordered the patient to press on differ- 
ent parts of the perinseum while he was making water; by which 
means he found, that, by pressing upon a particular spot, he could 
stop the water from flowing through the new passage. He was di- 
rected, however, not to press too hard, for fear of forcing together 
the sides of the natural passage. Upon erections, the penis was bent 
to the side that had suffered; but in time the parts gradually recover- 
ed their natural form. 



SECTION III. 

Of Inflammation in the parts surrounding the Urethra. 

Inflammation, arising from distention and irritation of the ure- 
thra, often extends considerably further than the surface of that ca- 
nal; for the surrounding parts become the seat of inflammation, the 
situation of which will commonly be according to the situation of the 
stricture producing the distention. Thus we find the inflammation 
affecting the prostate gland, the membranous part of the urethra, the 



HG SUPPOSED CONSEQUENCES CHAP. VI. 

bulb, and probably Cowper's glands, with other parts of the ure; lira 
between the bulb and the glans. But inflammation in the sun fund- 
ing parts of the urethra is not always a consequent e of distention or 
stricture; it arises often from other irritations in this canal, such as 
violent gonorrhoeas, and very irritating injections. When inflamma- 
tion attacks these parts, it is of the true adhesive kind; and there- 
fore when suppuration takes ;/ace an abscess must be formed, unless 
the inflammation be resolved. The matter, according to a general 
principle in abscesses, points externally; when the seat of the ab- 
scess is either in the prostate gland, membranous part, or in the bulb, 
the matter will point in the perinaeum; or the abscess may be formed 
forwards in the scrotum, or before it, according to the situation of the 
stricture. 

The seat of these abscesses is generally so near the inner surface 
of the urethra, that the partition between them often gives way, and 
they open internally, as frequently happens in an abscess by the side 
of the rectum, so that the matter is at once discharged by the ure- 
thra, or carried back into the bladder to be discharged with the urine. 
When the internal opening only takes place, I believe it is owing to 
the ulceration on the inner surface of the urethra, as has been al- 
ready described; and in these cases also the stricture is sometimes 
involved in the abscess and ulceration, by which means the water 
will find a free passage forwards; but the urine has also a free pass- 
age into the abscess, which we may suppose retards its healing, and 
often becomes the cause of its opening externally; but here, from 
the adhesive inflammation having taken place, the urine cannot insi- 
nuate itself into the surrounding cellular membrane, so as to produce 
the consequences mentioned in treating of the way in which Nature 
endeavours to relieve herself. In such cases we find that, upon press- 
ing the abscess externally, the matter is squeezed into the urethra, and 
so out by the glans. It sometimes happens, that a catheter can be in- 
troduced into the opening of such an abscess, by which means it car; 
be washed by injecting something through the catheter, whereby pro- 
bably it may be sooner healed. It more frequently happens', that 
such abscesses open both internally and externally, discharging 
themselves both ways. 

These ulcerations and suppurations, of both kinds, are to be con- 
sidered as efforts of Nature; or, to speak more physiologically, as a 
natural consequence arising from such irritation,*by which, "as the 
urine cannot pass by the old passage, a new one is made, to prevent 
further mischief. 

Both these diseases, when they open externally, if not properly 
treated, often lay the foundation for the complaint' commonly calie'd 
the fistula in perinaio; which is owing to the bottom of the abscess 
having a less disposition to heal than the external parts. It may be 
further supposed, that the urine passing into the abscess by the inner 
orifice, and making its escape by the external, keeps up a constant ir- 



SECT. IV. OP GONORRHOEA. 147 

ritation in the sore, which in some measure may prevent an union of 
the sides, and rather dispose them to form themselves into a hard cal- 
lous substance, the inner surface of which loses the disposition to 
union, and assumes the nature of an outlet. 

But it is mote than probable that the cause which prevents these 
abscesses from healing depends upon their first action often continu- 
ing in full force, that is, a diseased state of the internal parts, as will 
be further illustrated when we shall treat on the fistula in perinaeo. 
They often heal up at the orifice in the skin, especially if the water 
has a free passage forwards; but if the internal opening is not per- 
fectly consolidated, some water will insinuate itself into the old sore, 
become the cause of fresh inflammations and suppurations in the sur- 
rounding parts, which frequently open externally in different places, 
not following the old canal, although they sometimes communicate 
with it, and form branches, as it were, from the principal trunk. I 
have seen the scrotum, perinaeum, and inside of the thigh, full of open- 
ings, which were the mouths of so many sinuses leading to the first 
formed abscess. When the abscess opens only externally, which is 
seldom the case, it is to be considered as a common abscess. 

When these inflammations arise from stricture, the difficulty in 
making water is increased in the time of the inflammation, which is 
generally so great as to compress the sides of the urethra together for 
some way; besides, the stricture itself will become tighter from being 
inflamed. Inflammation in these parts, even when it does not arise 
from a stricture, brings on a suppression of urine; but in such cases, 
a bougie or catheter can be passed; the latter of which, in cases of 
obstruction arising from contiguous swellings, as tumors, inflamma- 
tions, and swelled prostate gland, is the proper instrument, as the 
sides of the urethra would be pressed together immediately upon 
withdrawing the bougie, by which the urine would be as much nr. 
ever prevented from following. 



SECTION IV. 

Oftlie Treatment of the Inflammation in the surrounding Parts 

The inflammation of these parts is to be treated like other inflam- 
mations. Resolution is much to be wished for; but it is almost im- 
possible it should take place where stricture is the cause. When the 
stricture is removed, either by ulceration or a bougie, we have only 
the inflammation to contend with; but this seldom happens, for the 
inflammation is but too often accompanied with suppuration. 

When suppuration takes place, the sooner the abscess is opened 



148 SUPPOSED CONSEQUENCES CHAP- VI. 

externally, the better, as that may in some cases be the means, 
though seldom, of preventing its opening internally; yet it may pre- 
vent the inner opening from becoming so large as it otherwise might 
be. The opening externally should be large; and if the stricture is 
not involved in the suppuration, then it must be destroyed; because 
there can be no cure while the water passes through the new open- 
ing. I have succeeded with the caustic even in strictures of long 
standing. 

When the stricture will admit of the passage of a bougie through 
it, it is to be kept almost constantly in the urethra, and to be with- 
drawn only at the time of making water; this will allow the urine 
to, pass more freely through the urethra, without escaping through 
the sore. The sore must be healed from the bottom. 

Hollow bougies are recommended in such cases, after the stricture 
is destroyed, to prevent the urine passing through the wound. This 
instrument admits of a constant dribbling of urine through it; but the 
bougie may be occasionally stopped up, and the urine permitted to 
pass when there is a desire to make water. It becomes, under cer- 
tain circumstances, the worst instrument possible; for if its canal is 
not of a size sufficient to let the water pass as freely as the contrac- 
tion of the bladder requires, the water will pass easily by the side 
of the bougie to the abscess, and not getting forwards beyond the 
stricture, flow out at the abscess: to avoid this effect as much as 
possible, the hollow bougies should be as large as the strictured part 
will allow, and its sides should be as thin as possible, that its pass- 
age may be the larger. The elastic gum has these two properties 
in a higher degree than the spiral wire covered with waxed cloth. 
But, as I doubt very much that the passage of the urine may be an 
hinderance to the healing of the sore, I am the less solicitous about 
such practice; for we find, that after lithotomy the parts heal very 
readily; and, even in this operation, the external parts which are 
not diseased heal up very readily. I suspect that the want of dispo- 
sition to heal arises from the strictures not being sufficiently subdued, 
or the deeper parts not being in a healthy state. 

When these suppurations are left to themselves, and no method 
tried to remove the stricture, and of course nothing introduced into 
the urethra, the stricture sometimes closes entirely, so that no water 
can pass forwards through the urethra; and therefore before any at- 
tempt can be made to heal the fistulous orifices, a passage must be 
made through the united parts. This cannot be done with a bou- 
gie; and if this union of the parts is before the bend of the urethra, 
which most commonly it is, nothing but the caustic can be applied 
with any prospect of success, as we shall mention more fully in treat- 
ing of the fistula in perinaeo. 



*MT- f. OF GONORRHfltAl. 149 



SECTION V. 

Of the Effects of Inflammation in tlie surrounding Parts upon the Con- 
stitution. 

The effects which these attempts to form a new passage for the 
mine have upon the constitution are very considerable; much more 
so than what one would at first expect. Those cases appear to be 
most formidable which begin by ulceration on the inner surface of 
the urethra, and where the water diffuses itself into the cellular mem- 
brane of the scrotum and penis. 

Those where the inflammation is circumscribed are more of the 
true abscess, and therefore do much less mischief to the parts than 
when the urine is diffused in the cellular membrane. In these last, 
if not soon relieved, the patient sinks, and a mortification comes on. 
If, before the patient sinks, a separation of the slough takes place, this 
separation performs the operation of opening, and the patient may 
recover. We should not, I believe, wait for such separation of the 
mortified part, but make an opening early, upon the first knowledge 
of a diffusion of water into the cellular membrane; and we should be 
"•uided as to situation by introducing a staff into the urethra on to the 
stricture. But in some cases this cannot be done; for when the urine 
gets into the corpus spongiosum, it produces mortification of all these 
parts, and renders the whole so indistinct that often no urethra can. 
be found. 

The effects that the circumscribed inflammation has upon the con- 
stitution is generally not so serious as the above, for mortification as 
seldom takes place in this as in abscesses in general. When the )- 
scess is from the bulb backwards, there is generally a smart sympa- 
thetic fever, because the abscess will be of considerable size before it 
«-ets to the skin of the perinaeum, and is generally attended with great 
pain; but this pain goes off by the formation of the matter, especially 
if opened early. 

As there is a great disposition to violent action, attended with great 
weakness in such cases, more especially in those of the first kind, it 
is advisable to give the bark early, and in considerable quantity; but 
I apprehend it is necessary to give along with it sudorifics, as some of 
the preparations of antimony, there being generally a good deal of 
fever. The bark gives strength, and also in some degree lessens ir- 
ritability; but it should be assisted by other medicines. 



150 SUPPOSED CONSEQUENCES CHAP, tt. 

SECTION VI. 

Of Fistula in Perinmi. 

It often happens that the new passages for the urine do not heal 
on account of the stricture not being removed; and even when the 
stricture is removed, they frequently have no disposition to heal. In 
both cases they become fistulous, and produce fresh inflammations 
and suppurations, which do not always open into the old sore, but 
make new openings externally. These sometimes arise from the 
first external openings not being sufficiently large, so that they heal 
up long before the bottom, or long before the diseased urethra; and 
even when the external opening has been made as large as possible, 
it will often heal sooner than the bottom, and become fistulous 
at last. 

It is very common for these diseases to affect the constitution, so 
as to bring on complaints of an intermittent kind. I have seen seve- 
ral affected with regular agues, where the bark has produced no 
effect; but whenever the obstruction has been got the better of, or the 
fistulous orifice opened and in a state of healing, these complaints 
have entirely gone off. 

To cure this disease, it is necessary first to make the natural pass- 
age as free as possible, that no obstruction may arise from that 
quarter; ancLsometimes this alone is sufficient; for the urine, finding 
a free passage forwards, is not forced into the orifice, and the fistula? 
heal up. The bougie may bring on an inflammation on the urethra 
at this part, and produce adhesions there; but if this effect is not 
produced early, the bougie will rather do harm if applied too often, 
and too long at a time, as will be more fully explained. But the 
dilatation of the stricture is not always sufficient: it is often necessary 
to perform an operation on the fistulas, when they alone become the 
obstacle to the cure, which I shall now describe. 



SECTION VII. 

Of the Operation for Fistuloz in Perinoeo, 

When the before-mentioned treatment is not sufficient for the 
cure of the new passages, a method should be followed similar to 
that used in the cure of fistulas in other parts, by laying them freely 
open to the bottom, and even making the orifice in the urethra a 



SECT. VII. OF GONORRHCEA. 151 

fresh sore, if possible. This will be difficult in many situations of 
the internal orifice; and the mode of opening, and other cir- 
cumstances attending the operation, will vary according to the 
situation. 

That as little of the sound part of the inner surface of the urethra 
may be opened as possible, and that the diseased part may be fully 
exposed, it is necessary to be well directed to the inner orifice, for 
which we have commonly two guides, one is a staff introduced into 
the urethra as far as is thought necessary, or as far as it will go, 
(which will only be to the stricture, where the stricture still exists, 
or it may pass on to the bladder in cases where the stricture has been 
destroyed;) the other guide is a probe passed into the fistulous orifice. 
The probe should be first bent, that it may more readily follow the 
turns of the fistula, and introduced as far as possible; if it could be 
made to meet the staff, so much the better, as then the operator could 
cut just what is necessary. If the fistula is tolerably straight, so as 
to admit the passing a director, it is the best instrument for operat- 
ing upon. If neither the probe nor the director can be made to pass 
on to the staff, we must open as far as they go, and begin searching 
anew after the remainder of the passage with the same instrument, 
and pursue it till the whole fistulous canal is laid open. If there are 
any sinuses, they are to be laid open, if possible; but it frequently 
happens that they cannot be followed by the knife, some running 
along the penis, where the scrotum is attached, others passing on to- 
wards the pubes, round the penis, while others are about the mem- 
branous part of the urethra. In such cases some degree of violence 
may be used, and I have several times introduced my finger into 
these sinuses, and have torn the parts so as to produce a consi- 
derable inflammation, by which means they often suppurate, granu- 
late, and unite. 

If the situation of the internal orifice is opposite to the scrotum, it 
will be difficult to get to it; but I imagine we may use great freedom 
with the external parts, whatever they are, for they are generally in 
a state of callosity. However, this requires judgment. 

In cases where the disease is before the membranous part, and the 
stricture is not removed, a staff cannot be made to pass on to the 
inner orifice. In such the fistulous opening must be followed by the 
introduction of a probe or director into it, and by dilatation upon the 
instrument, till the urethra beyond the stricture is found; and then a 
probe must be passed on towards the glans, to meet the end of the 
staff at the stricture; similar to what is done in the operation where a 
passage has been made by the mismanagement of the bougie. 
The stricture must then be destroyed, and a bougie passed, as was re- 
commended in that operation. 

If either the ulceration, or the abscess, is formed in or near the 
prostate gland, then probably the stricture is near that part. In that 
case a staff mttst be pass* d as far as possible, and a probe or director 



\b'Z SUPPOSED CONSEQUENCES CHAP. V!. 

introduced into the external orifice, and the operation is to be direct- 
ed accordingly. The difference of the operation in this case from the 
former will be, that we shall most probably be obliged to cut into the 
urethra on both sides of the stricture, therefore more of the canal 
must be exposed. 

As this operation is the opening of all the fistulous canals, and also 
the destruction of the stricture, if there has been one, an instrument 
can afterwards, in every case, be passed into the bladder. It will 
most probably always be proper to introduce an instrument into the 
bladder, and keep it there almost constantly, so as to preserve the 
passage of the urethra in a regular form, while the openings made 
are healing; and probably the catheter will be by much the best in- 
strument, because it is not necessary to be withdrawn whenever the 
necessity to make water comes on, which a bougie must; and its in- 
troduction again is often not practicable, for its end will be apt to get 
into the wounds. 

In such cases as require a hollow cannula to be left in the bladder 
for the purpose of drawing off the water, whether a catheter or hol- 
low bougie, it is absolutely necessary it should be fixed there, or else 
it will in common come out by the actions of the part. To effect 
this, it is necessary to fix that end of the instrument out of the penis 
to some part of the body that is the least moveable: what will answer 
extremely well is the common belt-part of the bag-truss, with only 
two thigh-straps fixed behind, and made to tie or buckle before ; and two 
or three very small rings or short tapes fixed to those straps; where 
they pass between the thigh and scrotum, they should not be at a 
great distance from one another where they are fixed behind to the 
belt, for otherwise they are much altered in tightness by the motion 
of the thigh. If they have a flat spring in them, so much the 
better.* 

The common bag-truss for the scrotum answers extremely well, 
first by fixing two or three rings on each side of it along the side of 
the scrotum, and with a piece of small tape the ring of the cannula 
can be fastened to any one of those rings that is most convenient for 
its situation. 

Whatever instrument is used for the purpose of keeping the pass- 
age clear and open while the sores are healing, whether the sores 
are in consequence of this operation, or in consequence of the causes 
of the fistulas, which I have described, there is a limited time in 
many cases for its continuance; for if continued beyond a certain 
period, it frequently acts contrary to what was intended: at first it 
often assists the cure, but towards the last it may obstruct the heal- 
ing of the sores by acting at the bottom of the wound as an extra- 
neous body. Therefore, whenever the sores become stationary, I 



* Mr. VanbutchelTs springs would answer very well. 



SECT. VII. OF GONORRHOEA. 153 

would advise the withdrawing of the instrument, and the introducing 
it only occasionally. The catheter will probably be still the best in- 
strument for this purpose, as it will pass more readily, and draw off the 
water at the same time: however, I have often used a bougie, and by 
great care have passed it with success; and probably it will be pro- 
per to use it every now and then, even when all is healed, in order to 
determine whether or not the passage is free from disease. 

The sore and the wound are to be at first dressed down to the bot- 
tom as much as possible, which will prevent the re-union of the parts 
just divided, and make the granulations shoot from the bottom so as 
to consolidate the whole by one bond of union. 

When the urethra has suffered so much that abscesses have formed 
beyond the scrotum, the patient should ever after take great care to 
avoid a fresh gonorrhoea, for he seldom in that case escapes a return 
of the same complaints; and indeed, if he is not careful in many other 
respects, he is liable to returns of the same disease. If, notwith- 
standing this precaution, he should contract a gonorrhoea, every 
thing healing is to be carefully avoided, particularly irritating in- 
jections. 

The following case shows that keeping extraneous bodies in the 
urethra prevents wounds made into that canal from healing. 

A man, aged twenty-six, came into St. George's Hospital, March 
2, 1783. He had laboured under a fistula in perinceo for near two 
years, arising from a stricture, attended with great pain and difficulty 
in miking water. Four fistulous orifices were to be observed in the 
perinaeum and scrotum. The smallest bougie could not be made to 
pass into the bladder after repeated trials. The caustic was then ap- 
plied, but without success. 

The operation for the fistula in perinaso was performed, Septem- 
ber 19. A catheter was first introduced as far as it would go, as a 
director, and all the sinuses were laid open to that catheter, which 
exposed near an inch in length of that instrument; then the catheter 
was in part withdrawn to expose that part of the urethra which was 
laid bare. The blood being sponged off, the orifice in the stricture 
was next searched for, and when found it was dilated. The cathe- 
ter was now pushed on to the bladder, although with some difficulty, 
and tiie end of it was then fastened to a roller which went round the 
thighs; and the wound was distended with lint. He took an anodyne 
draught after the operation, and another at night. September 20, 
he had some pain in the head from the opiates; his pulse was natural, 
and lie had slept tolerably well. On the 21st day the catheter slip- 
ped out, and the second introduction of it gave considerable pain. 
The anodyne was repeated. October 1. The catheter was still to 
be iMt bv introducing a probe into the wound. From this time to 
the 25th, nothing material happened, excepting a piece of lint, of the 
first dressing, coming away through the urethra. November 20. 
The wound having for some time been stationary, and shewing n© 



154 SUPPOSED CONSEQUENCES CHAP. VII. 

disposition to heal, I conceived that the catheter was now acting as 
an extraneous body at the bottom of the wound, and therefore de- 
sired that it might be withdrawn, and passed occasionally; and no 
sooner was the wound free from it but it put on a healthy look; and 
by the 10th of December no urine came through the wound, but 
passed tolerably well through the urethra; and on the 12th, the 
wound was quite healed, and his water came from him rather in a 
full stream, and without pain, although we could never pass either 
catheter or bougie afterwards, probably from the new and old pass- 
ages being irregular. 



CHAP. VII. 

Of some olher Affections of the Urethra. 

The substance of the urethra is muscular, and it is therefore 
capable of contracting its canal, similar to an intestine, so as to 
shut it up entirely. This makes it subject to diseases peculiar to 
muscle in general; which is indeed the only proof we have of its 
being muscular. 



SECTION I. 

Of the Spasmodic Affections of the Urethra. 

In a sound state of parts these muscles are never excited to violent 
actions, acting simply as sphincter muscles; but when irritated, they 
are capable of acting violently, as is best seen in some cases upon the 
first use of injections, the urethra often refusing the injection en- 
tirely. This seems rather to be a salutary motion to hinder things 
from getting into the bladder; but there are often spasmodic con- 
tractions of these muscular fibres in different parts of the canal 
shutting up the passage and obstructing the course of the urine' 
often not allowing a drop to pass. That this also is owing to spasm 
upon the muscular fibres is evident, because a large bougie will 
sometimes pass when it is at the worst. When the contraction is 
near the bladder, it is called a strangury, and is often produced in 



SECT - '• OF GONORRHOEA, 155 

a sound state of parts by irritating medicines, the power of which 
fall upon these pails, as cantharides; and when this part is in an 
irritable state, the spasm may be brought on bv a vast number of 
things; such as most of the peppers, fermented liquors of all kinds 
violent exercise, &c. 

The urethra, in cases of spasmodic stricture, is more irritable than 
in the true stricture, which irritation indeed is in a great measure the 
cause of the spasm. Spasmodic strictures often bear so strong a re- 
semblance to the cramp, that one would be apt to attribute them to 
the same cause as that which produces cramp. In such cases the 
spasm also goes off by tickling the part, similar to the removal of 
cramp. 

In all cases of very irritable urethras, where spasms very readily 
take place, the patient should never long retain his urine when he has 
an inclination to void it; for I have seen cases where this alone has 
brought on the spasm; and indeed these parts, when in perfect health, 
will be thrown into a spasmodic affection, if the urine is too long 
confined in the bladder; while, at the same time, a certain fulness of 
the bladder, or a small degree of retention of the urine, will make the 
bladder contract with more force; and the urethra will, for the same 
reason, relax more freely; therefore, in cases where there is a tenden- 
cy to strangury, there is seldom any harm in waiting a little after the 
inclination comes on. 

I may be allowed here to caution surgeons who have not had oppor- 
tunities of seeing many of these cases, when they meet with perma- 
nent strictures which are becoming troublesome, attended with fre- 
quency in making water, and a difficulty in passing it often threaten- 
ing strangury, not to advise, or rather not to allow, their patients to 
take long journies, either on horseback or in carriages, more especi- 
ally in the winter. I have known many patients labouring under such 
complaints taken ill in the middle of a journey, and obliged to stop 
for days upon the road, and who have continued in misery the re- 
mainder of the journey; and after having arrived at the place of their 
destination, have been laid up for months, and have suffered from 
most of the before-mentioned complaints. 



156' SUPPOSED CONSEQUENCES CtfAP. VII. 

SECTION II. 

Of the Owe of the Spasmodic Jlffection of the Urethra. 

It may not be improper to premise, that in diseases of the actions 
only of the urethra and bladder, whether spasmodic, and proceeding 
from too great irritability, or paralytic, (although two opposite dis- 
eases,) irritations on other parts have often wonderful effects, equally 
diminishing the action in the one, and increasing it in the other. The 
proof of this will appear when we shall treat of the irritable and 
paralytic urethra and bladder; for in either part, and in either case, 
we find blisters applied to the lower part of the small of the back, or 
the perinasum, as also many other applications to this part, often pro- 
duce great effects.* 

As spasm simply is not an alteration of structure, but is only a 
diseased or preternatural action arising from some irritation, it may 
be made to cease instantaneously. In whatever part of the urethra 
the spasm is, if time will allow, it is proper to try internal medi- 
cines, and also external applications, to remove it. The internal me- 
dicines that may be said to act immediately are, opiates and turpen- 
tines,! given either by the mouth or the anus; but they are more im- 
mediate in their effects in the form of clyster, especially the opium. 
Bark is often had recourse to in spasmodic affections, in which it is 
thought to be of service; but in such affections of the urethra, I think 
I have seen it frequently do harm. # 

The external applications are, the steam of warm water with 
spirits, the pediluvium, the warm bath, bladders of warm water ap- 
plied to the perinasum, and similar applications. The crumb part 
of a new baked loaf, warm from the oven, applied to the perinasum, 
has been found to give ease. 

I have known a blister, applied to the loins, in a great measure re- 
move the spasm from the urethra; it is equally effectual when appli- 
ed to the perinaeum. But in most cases these methods are too tedi- 
ous; therefore, when the case has been of some standing, before assist- 
ance has been called for, and requires immediate relief, recourse 
should be had to the catheter or bougie immediately. 

* That the parts concerned in the expulsion of the urine (as the bladder and 
urethra) sympathize strongly with the skin of the perineum, I believe is com- 
monly supposed, from applications being often made to that part in cases of 
stoppages ot urine. 

A gentleman, who had no complaint in these parts, had a small fistula at the 
side of the rectum, for which he often had occasion to sit over the steam of 
warm water and vinegar; and this application to the perinxum never failed of 
mating him void his urine. 

-j- Dr Home, in his experiments on this medicine, found that large doses 
or Light on the strangury in women. 

Strangury is the frequent effect of spirit of turpentine taken for some time. 



* ECT> "*• OF GONORRHOEA. 157 

If the contraction is near the bladder, the catheter will answer 
best; but in most cases the bougie will be sufficient, and is a much 
safer instrument; for in many hands the catheter is a very dangerous 
one, requiring a dexterity only to be acquired by a thorough know- 
ledge of the course of the canal, and a habit of passing it. The bou- 
gie has likewise this advantage, that in many cases, where the part 
spasmodically affected will not allow it to pass, it may be allowed to 
lie close to the stricture; for it is not always necessary for the bougie 
to pass through the constrictured part; for a bougie, which has only 
passed a very little way in the urethra, has sometimes been effectual, 
if suffered to stay there till the desire of making water is perceived. 

In such cases, even when the bougie passes into the bladder, it is 
necessary to let it stay in the passage till the inclination to make wa- 
ter comes on. If the water does not follow on the first attempt, it 
will be proper to make another; or if only part follows the bougie, it 
will be necessary to introduce it again. This circumstance of the 
water following the bougie with more certainty, if it is allowed to 
stay till the inclination comes on, is a proof that the disposition in the 
bladder to contracting removes in some degree the disposition to con- 
traction in the urethra. 

Some attention is necessary with respect to the passing of the bou- 
gie in these cases; for the urethra being more irritable than common, 
it often resists the bougie before it reaches the true spasmodic part. 
When this is the case, force is not to be used; but we should ra- 
ther wait a little with patience, and then make another attempt to 
push it on. Dipping the end of the penis in very cold water often 
removes the spasm, and the water flows immediately and freely. 

In most cases there is an uneasy sensation at the end of the penis, 
which leads the patient to rub those parts, and sometimes, though 
rarely, during the friction, the water will pass. Gently irritating 
injections, thrown in only a little way, often give ease. They may 
be supposed to act in a manner somewhat similar to a bougie that 
does not pass, and by irritating one part of the urethra to produce a 
relaxation in the other. They act in some cases as a preventative. 



SECTION III. 

Of the Paralysis of the Urethra. 

In opposition to the foregoing disease, there is the want of power 
of contraction of the urethra; but this is not so frequent a case as 
the former. This disease is attended with symptoms contrary to 
those of the foregoing; the bladder is hardly allowed to be filled so as 



158 SUPPOSED CONSEQUENCES CHAP. VII. 

to give the stimulus of repletion; but the water dribbles away insen- 
sibly as fast as secreted by the kidneys; or if the bladder is filled so as 
to receive the stimulus for expulsion, then it immediately takes place, 
and the water flows, if the person does not act with the musculi ac- 
celeratores; but sometimes in such cases the power of contraction of 
these muscles is lost, and then the water will flow, whether the per- 
son will or not, there being little or no power of retention. There is 
great difference in the degrees of violence of this disease. 



SECTION IV. 

Cure of the Paralysis of the Urethra. 

It is to be cured by stimulants, as a blister to the loins; or a blister 
to the perinaeum. It may be useful to immerse the feet in cold wa- 
ter. Tincture of cantharides, taken internally, fifteen or twenty drops 
once or twice a day, according to the effects, are of singular service 
in some cases. 

A man came to St. George's Hospital with this complaint. I or- 
dered him the before-mentioned medicine; and it had such an effect 
as to bring on the contrary disease, or a spasmodic affection of the 
urethra, so that he could not make water when he had the inclination: 
but an injection of opium removed this complaint, and he was then 
well. In this case, a few drops less probably would have effected a 
cure without any inconvenience. 



There appears a great uncertainty in the effects produced by can- 
tharides. In the case here described, in which we might have ex- 
pected the parts to be particularly insensible to stimuli, we find a dose 
of fifteen or twenty drops of the tincture producing spasm. How- 
ever, as soon as this immediate effect ceased, the remedy proved ser- 
viceable. Dr. Robertson of Edinburgh gives doses beyond compari- 
son greater, and with safety. In a case in the New Finsbury Dispen- 
sary, of incapacity to retain the urine, 3iss and 5ij of tincture of 
cantharides were given three times a day with much advantage. An 
attempt was made to give the remedy in substance, but we never could 
find a dose small enough, if it produced any effect whatever. 



SECT. VI OF GONORRHOEA. 159 

SECTION V. 

Of Caruncles or Excrescences in the Urethra. 

Strictures are not supposed to be the only causes of obstruction 
to the passage of urine in this canal; excrescences or caruncles are 
likewise mentioned by authors as happening frequently. From the 
familiarity with which they talk of them, and the few instances in 
which they really occur, one would suspect that this cause of ob- 
struction was originally founded in opinion, and not observation, and 
afterwards handed down as matter of fact. If caruncles had been at 
first described from actual examination of cases, the language would 
have accorded with the appearances, and they would have been con- 
sidered as seldom the causes of obstruction compared with strictures. 
However, they do sometimes happen, although but rarely. I have 
in all my examinations of dead bodies seen only two, and these were 
in very old strictures, where the urethra had suffered considerably. 
They were bodies rising from the surface of the urethra like granu- 
lations, or what would be called polypi in other parts of the body. 
It is possible they may be a species of internal wart; for I have seen 
warts extend some way into the beginning of the urethra, having 
very much the appearance of granulations. Most probably it will 
not be possible in the living body to distinguish caruncles, excres- 
cences, or risings in the urethra, from a stricture; for I cannot con- 
ceive that they can produce any new symptoms, or peculiar feel to 
the examiner. 

May they not also be produced by violent inflammation,- throwing 
out coagulating lymph, as has been observed when considering the 
process of inflammation? 



SECTION VI. 

Of the Cure oftlie Excrescence or Caruncle. 

I should very much suspect that this disease is not to be cured 
by the bougie; at least dilatation in such cases is not to be attempt- 
ed as there is no contraction. If therefore the bougie is of any use, 
it must be in making the carnosity ulcerate from its pressure, which 
probably may be done by a large bougie pressing upon it with con- 



160 SUPPOSED CONSEQUENCES tHAP. VIII. 

siderable force. But if this should not have the desired effect, I 
should certainly recommend or use the caustic, if the parts are so 
situated as to admit of the application; and from such practice I 
should not doubt of a cure. But the difficulty lies in distinguishing 
the disease from the true stricture; for although authors talk of ca- 
runcles as common, and give us the method of treatment, yet they 
have not told us how we are to distinguish them from strictures. 
I have never met with a caruncle in women. 



CHAP. VIII. 

Of the Sivelled Prostate Gland. 

Another disease of the parts surrounding the urethra, which is 
often very formidable, is a swelling of the prostate gland. This is 
of more serious consequence than any of the former causes of ob- 
struction, because we have fewer methods of cure, for we cannot de- 
stroy it as we do the stricture, nor can Nature relieve herself by 
forming new passages; we have, however, often the means of tem- 
porary relief in our power, which is not the case in the stricture; 
for most commonly we can draw off the water by the catheter. 

The swelling of the prostate gland is most common in the decline 
of life. The use of this gland is not sufficiently known to enable us 
to judge of the bad consequences that attend its diseased state, ab- 
stracted from swelling. Its situation is such, that the bad effects of 
its being swelled must be evident, as it may be said to make a part 
of the canal of the urethra, and therefore when so diseased as to alter 
its shape and size, it must obstruct the passage of the urine. When 
it swells it does not lessen the surface of the urethra at the part like 
a stricture; on the contrary, it rather increases it; but the sides of the 
canal are compressed together, producing an obstruction to the pass- 
age of the urine, which irritates the bladder, and brings on all the 
symptoms in that viscus that usually arise from a stricture or stone. 
From the situation of the gland, which is principally on the two sides 
of the canal, and but little, if at all, on the forepart, as also very little 
on the posterior side, it can only swell laterally, whereby it presses 
the two sides of the canal together, and at the same time stretches it 
from the anterior edge or side of the posterior, so that the canal, in- 
stead of being round, is flattened into a narrow groove. Sometimes 
the gland swells more on one side than the other, which makes an 
obliquity in the canal passing through it. 

Besides this effect of the lateral parts swelling, a small portion of 
it, which lies behind the very beginning of the urethra, swells for* 



CHAP. VIII. OF GONORRHOEA. 161 

wards like a point, as it were, into the bladder, acting like a valve to 
the mouth of the urethra, which can be seen even when the swelling 
is not considerable, by looking upon the mouth of the urethra from 
the cavity of the bladder in a dead body. It sometimes increases so 
much as to form a tumor,* projecting into the bladder some inches. 
This projection turns or bends the urethra forwards, becoming an 
obstruction to the passage of a catheter, bougie, or any such instru- 
ment; and it often raises the sound over a small stone in the bladder, 
so as to prevent its being felt. The catheter should, for this part, 
be more curved than is necessary for the other parts of the urethra. 
In such cases I have frequently passed first a hollow elastic catheter 
till it has reached this point, and afterwards a stilet or brass wire 
properly curved, so as to go over the prostate gland. The advan- 
tages of this method are, that, if the hollow catheter passes, no more 
is necessary; and, if it does not, the curved wire will pass along the 
hollow bougie much easier both to the surgeon and patient than it 
would have done if it had been introduced at first with the hollow 
bougie over it; for it would endeavour to adapt the urethra to the 
curve; whereas, when introduced afterwards, the stilet acts only 
on the inside of the hollow bougie, which the patient hardly feels. 

A gentleman had been often sounded for a stone, and yet no stone 
could be found; but it afterwards appeared that there was a stone, 
which, together with the swelling of the prostate gland, had been 
the cause of his death. 

John Doby, a poor pensioner in the Charter-house, had been se- 
veral years afflicted with the stone in the bladder, and was relieved 
from all the symptoms by an enlargement of this part of the pros 
gland, preventing the stones from falling down upon the neck of the 
bladder and irritating those parts. A twelvemonth after that the 
symptoms of the stone had gone off, he was attacked with a strangu- 
ry, to relieve which many ineffectual attempts were made both 
with the bougie and catheter; but it soon proved fatal. Upon ex- 
amination of the parts in the dead body, the prostate gland was 
found enlarged to a size six times greater than what it is in com- 
mon, and the urethra, passing through it, was a slit about an inch 
and a half in I-.igth, the two sides of which were close together, the 
upper end towards the pubes and the lower towards the rectum. 
This slit was formed by the sides of the prostate gland only swell- 
ing, and the right side was the most enlarged, having its surface next 
the urethra rounded or convex, and the left side was exactly fitted to 
it, having its surface hollowed in the same proportion. The small 
projecting point of the gland was so much enlarged as to come for- 
wards into the cavity of the bladder, and fill up entirely the passage 
at the neck of it. The bladder itself was very much enlarged and 
thickened in its coats, and contained above twenty stone-, most of 

Vkk Plates V. and VJ! 
s 



162 SUPPOSED CONSEQUENCES CHAP. VIII 

them lying behind the projecting process of the prostate gland, and 
the rest lodged in small saes, made hy the internal membrane being 
pushed some little way between the fasciculi of muscular fibres, 

The prostate gland', when- swelled, generally becomes firmer in its 
consistence. The effects of these swellings are very considerable, 
for they squeeze the sides of the urethra close together, and the pro- 
jecting point hinders in some degree the urine from entering the pass- 
age, and in many cases stops it entirely. Further, the increased 
firmness of the substance of the gland hinders it from yielding to the 
force of the urine, so that little or none can pass. It will be unne- 
cessary to relate the particular symptoms which this disease occa- 
sions; they are such as arise from any stoppage of urine, producing 
an irritable bladder. 

When a difficulty in making water takes place, a hougie is the in- 
strument which the surgeon will naturally have recourse to; and if he 
finds the passage clear, which he often will, in such cses he may very 
probably suspect a stone. If search is made and no stone felt, he should 
naturally suspect the prostate gland, especially if the sound or instru- 
ment used meets with a full stop, or passes with some difficulty just 
at the neck of the bladder. He should examine the gland.' This 
can only be done by introducing the finger into the anus, first oiling 
it well, placing the fore part of the finger towards the pubes; and if 
tJie parts, as far as the end of the finger can reach, are hard, making 
an eminence backwards into the rectum, so that the finger is obliged 
to be removed from side to side, to feel the wdiole extent of such a 
swelling, and it also appears to go beyond the reach of the finger, 
we may be certain the gland is considerably swelled, and is the 
principal cause of those symptoms. 

I have known cases where the common catheter has been pushed 
through the projecting part of the gland into the bladder, and the 
water then drawn off; but in one patient the blood from the wound 
passed into the bladder, and increased the quantity of matter in it. 
The use of the catheter w r as attempted a second time, but, not suc- 
ceeding, I was sent for. I passed the catheter till it came to the 
stop, and then suspecting that this part of the prostate projected for- 
wards, I introduced my linger into the anus, and f.und that gland 
very much enlarged. By depressing the handle of the catheter, 
which of course raised the point, it passed over the projection; hut 
unfortunately the blood had coagulated in the bladder, which tilled 
up the holes in the catheter so that I was obliged to withdraw it, and 
clear it repeatedly. This I practised several days; but suspecting 
that the coagulum must in the end kill, I proposed cutting him as if 
for the stone; hut he died before it could be conveniently done, and 
the dissection, after death, explained the case to be what I have now 
described. 

In some of those cases where this part of the gland swells into the 
bladder in form of a tumor, the catheter has been known not to 



CHAP. VIII. OF GONORRHCE.i I6S 

bring off the water at times when it appeared to have passed; and 
upon the death of the patient, when the parts have been examined. 
it was imagined that the catheter, in the living body, had made its 
way into the tumor, so as to have been buried in it at those times.* 

From the knowledge of the above-mentioned facts, whenever I 
find the urine does not flow immediately upon introducing the ca- 
theter into the bladder, I have pushed it on, and depressed the haif- 
dle so as to reach the fundus of the bladder with the end of the ca- 
theter, and have always succeeded. For the more ready introduc- 
tion of the instrument, a catheter, made flexible at the point only for 
about an inch, is perhaps best, as it is more under the command of the 
hand than when wholly flexible. 

If the bougie be used, it should be first warmed, and then very 
much bent at the point, and allowed to cool in this position, and 
passed quickly with the concave side upwards, before it loses the 
bend in its passage. But the bougie does not answer so well as the 
catheter, because, upon withdrawing the bougie, the sides of the gland 
soon close again. I have known where the water has passed by the 
side of the bougie with more freedom than when it was pulled out, 
because the bougie gave a straightness to this part of the canal, 
which it had not when the bougie was withdrawn. The following 
case is a strong instance of the inconveniences arising from such a 
.disease of the prostate gland. 

A gentleman was attacked with a suppression of urine; a catheter 
could not be passed, but a bougie relieved him. He continued well 
for five years; but the same complaint returning, the bougie could 
not be passed, and the disease was supposed to be a stricture. A 
catheter, however, passed, although with a good deal of difficulty; 
and the bougie, though often tried, could not be passed, excepting 
once, just after using the catheter. I was sent for, and tried the 
bougie with as little success, and was obliged to have recourse to the 
catheter. I passed it with great ease, and the water was drawn off. 
The late Mr. Tomkyns, who had Daran's bougie, was called; but 
he was not more successful, and was obliged to have recourse to the 
catheter; but such violence was used as caused a good deal of blood 
to come from the urethra, and after all it did not succeed. I was 
again consulted, and passed the catheter, but with much more diffi- 
culty than before, which made me believe that the passage had been 
a good deal torn. Upon taking out the catheter, I passed a large 
bougie into the bladder with great ease; this 1 allowed to remain for 
three days, and the patient made water tolerably freely by the side 
of it. The moment I drew out the bougie I attempted to pass ano- 
ther, but did not succeed, although I. gave it the natural bend of the 
passage. Upon withdrawing those bougies that did not pass, I ob- 
served that all of them had a bend at the point, contrary to the direc- 

• Vide Plate VII. 



164 SUPPOSED CONSEQUENCES CHAP. V1JI. 

tion of the passage; this made me suspect, that the place which 
stopped the bougie was on the posterior surface, and that, by being 
pushed on, it bent forwards into the passage, and of course the point 
turned back. I therefore took a thick bougie; and, before I intro- 
duced it, I bent the point almost double, so that it could not catch at 
the posterior surface of the urethra, where I supposed the stop to be: 
this point of the bougie rubbed all along the auterior and upper sur- 
face of the urethra, by which means it avoided catching on the pos- 
terior surface, and it' passed with great ease into the bladder. He 
made water by the side of the bougie as before. He had been for 
some time troubled with fits of an intermittent, which at first Wert 
very irregular, but became afterwards more regular. In one of the 
cold fits, the bougie, being in the urethra, gave him great pain, and 
obliged him at last to pull it out, on which he had immediate ease. 
The sensation was as if it stretched the passage too much, and it 
seemed to come out with difficulty. This looks as if there was a 
contraction of the urethra, as well as of the vessels of the skin, in 
the cold fit; so that this disposition runs deep. By giving the bougie 
this bend, he was able for the future to pass them with great ease. 
I may just observe, that, by introducing the finger into the anus, I 
found the prostate gland much enlarged. 

Many patients, while labouring under any of the before-mentioned 
diseases of the urethra, and sometimes even after they have been 
cured of them, find great pain in throwing forwards the semen, having 
a sensation as if it scalded. This arises from the very irritable state 
which the muscles of this part are in, giving great pain by their own 
action. 



SECTION I. 

Oj the Treatment of the Swelled Prostate Gland. 

The methods practised in the above cases afforded only temporary 
relief; yet such must be had recourse o in order to prevent the con- 
sequences of retaining the urine too long. As a temporary relief 
horn pain, as also to remove spasm, opiate clysters should be'thrown 
up once or twice a day. A certain cure, I am afraid, is not as yet 
discovered. 

I have seen hemlock of service in several cases. It was given 
upon a supposition of a scrofulous habit. On the same principle I 
have recommended sea-bathing, and have seen considerable advan- 
tages from it; and, in two cases, a cure of some standing. 

In one case in which I was consulted the surgeon had found that 
burnt sponge had reduced the swelling of the gland very consider- 
ablv. 



CHAP. IX. OP GONORRHOEA. 1G5' 

This disease, like the stricture, produces complaints in the blad- 
der; but in this the bladder is generally more irritable, perhaps from 
the cause being nearer to that viscus. 

Diseases of the vesiculae seminales are very familiarly talked of; 
but I never saw one. In cases of very considerable induration of 
the prostate gland and bladder, where the surrounding parts have be- 
come very much affected, I have seen these bags also involved in the 
general disease; but I never saw a case where it appeared that they 
were primarily affected. 

In a case of a swelled prostate gland, with symptoms of an irritable 
bladder, in a young gentleman about twenty years of age, Mr. Earle 
tried a blister to the perinaeum; but not finding the desired effect, 
and conceiving a greater irritation and discharge to be necessary, he 
passed a seton in the direction of the perinaeum. The orifices were 
about two inches distant from each other. The symptoms of irrita- 
bility in the bladder began to abate, and in time went entirely off. 
Upon examination of the prostate gland, from time to time, it was 
found to decrease gradually till it was nearly of the natural size. 
The seton was continued some months, and upon its being withdrawn 
the symptoms began to return. It was advised to introduce it again; 
which was accordingly done, but without the former good effects. 



CHAP. IX. 



Of the Diseases of the Bladder, particularly from the before- 
mentioned Obstructions to the Urine. 

All the diseases of the urethra, as also the diseases of the prostate 
gland, I have now treated of, and shall next consider the effects of 
them upon the bladder, as also the diseases of that viscus, independ- 
ent of affections of the urethra. 

The disease of the bladder, arising from obstruction alone, is in- 
creased irritability, and its constepjences, by which the bladder ad- 
mits of little distention, becomes quick in its action, and thick and 
strong in its coats. But prior to the description of the effects of the 
diseases of the urethra on the bladder, it will be necessary, for the 
better understanding of the whole, to make some remarks upon those 
diseases of the two parts, in which we find that each affects the 
other; and these I shall consider without having any regard to the 
cause, but only to the general effects, when they are diseased. It 
ma\ be observed, that every organ in an animal body is made up of 
different parts, the functions or actions of which are totally different 



166 SUPFOSL& tDNSEQUENCES CHAP. IX. 

from each other, although all tend to produce one ultimate effect. In 
most, if not in all, when perfect, there is a succession of motions, one 
naturally arising out of the other, which in the end produces the ul- 
timate effect; and an irregularity alone in these actions will consti- 
tute disease, at least produce very disagreeable effects, and often to- 
tally frustrate the final intentions of the organs. 

I may be allowed also to premise, that the natural width of the 
urethra gives such a resistance to the force or power of the bladder 
in expelling the urine, as is easily overcome by the natural action of 
the bladder; but when the canal is lessened, either by stricture, 
spasm, swelled prostate gland, or any other means, this proportion 
is lost, by which means the bladder finds greater difficulty than na- 
tural, and is -of course thrown into an increased action to overcome 
the resistance, which becomes a cause of the irritability and in- 
creased strength of this viscus in. such diseases. 

It is to be understood, that, in a sound state of these two parts, the 
bladder and urethra, the contraction of the one produces a relaxation 
of the other, and vice versa; so that their natural actions are alter- 
nate, and they may be considered as antagonist muscles to one an- 
other. Thus, when the stimulus of expulsion of the urine takes place 
in the bladder, which immediately produces contractions in it, the 
urethra relaxes, by which means the urine is expelled from the blad- 
der, and allowed to pass through the urethra; and when the action 
ceases in the bladder, the urethra contracts again like a sphincter mus- 
cle,* for the purpose of retaining the urine which flows into the blad- 
der from the kidneys till it gives the stimulus for expulsion again. 
But in many diseases of these two parts, this necessary alternate ac- 
tion is not regularly kept up, the one not obeying the summons of the 
other. This irregularity arises perhaps oftener from disease in the 
urethra, than in the bladder; for the action of the urethra depends 
upon the actions of the bladder; and if it is not disposed to obey the 
notices of the bladder, then there must be an irregularity as to time, 
which produces very troublesome symptoms. 

We find, in many diseases of the urethra, such as strictures and 
spasms, as also in diseases of certain parts belonging to this canal, 
such as the prostate, and Cowper's glands, that there is a greater dis- 
position in this canal for contraction than common, so that, when the 
bladder has begun to act, the water is not allowed to flow, the ure- 
thra not immediately relaxing; and the moment such a symptom 
takes place, every other power takes the alarm, and is brought in to 
assist the bladder, such as straining violently with the abdominal 

' I: may be remarked, that many sphincter muscles have two causes of action ; 
one, winch may be called involuntary, depending- on the natural uses and actions 
<A toe parts; the other is voluntary, where a greater degree of action can be 
produced by the command of the will: and when a diseased action takes place, 
it is probably of Urn voluntary action; fry ;• is an increased action over tii<- nattt- 
I II) ■>• v is. 



CHAP. IX. OF GONORRHOEA. 167 

muscles, and muscles of respiration, from all which there is violent 
pain in the parts immediately concerned, especially in the glans 
penis. 

Tliis disease has different degrees of violence. When slight, the 
distance in time between the contraction of the bladder and the re- 
laxation of the urethra is but short, only giving a momentary pain 
and straining, before the urethra relaxes, and the water Hows accord- 
ing to the dilatation of the urethra, which, in many of these cases, is 
but very small. In others the distance of time is very long, many 
straining for a considerable time before a drop will come; and what 
does come is often only in drops; and sometimes, before the whole 
urine can be expelled in this way, the spasm of the urethra comes 
on again, and there is a full stop, which gives excruciating pain for 
a while; but at last the bladder is as it were tired, and ceases to act. 
But as the urine in such cases is seldom all discharged, and often but 
a very little of it, the symptoms soon recur; and in this way, with 
a call to make water perhaps every hour out of the four and twenty, 
the patient drags on a miserable life. 

The bladder, in all cases of obstruction, whether constant, as in 
the permanent stricture, or swelled prostate gland; or only tempo- 
rary, as in the spasmodic stricture, is generally kept distended, but 
much more so in the permanent stricture; and when the irritation of 
fulness comes on, which is very frequent, the contraction of that vis- 
cus becomes violent, in proportion to the resistance: the sympathetic 
contraction of the muscles of the abdomen takes place, and is also 
violent, yet the water at such times shall only dribble, and be dis- 
charged in small quantity; and in the spasmodic stricture often not a 
drop shall pass, so that the bladder is never entirely empty; and 
what does pass is no more than sufficient to take off the irritation of 
fulness; by which means these actions become more frequent, and 
consequently there is almost always a constant oozing of urine from 
the penis between the times of making water. This, however, is 
not always the case; for the bladder is sometimes so irritable as not 
to cease acting till it has evacuated the whole water; and even then 
it is not at ease, but still strains, though there is nothing, to throw 
out, the action of the bladder becoming a cause of its own conti- 
nuance. 

In all such affections of the bladder there is a sensation of pain 
and itching combined in the glans penis. 

If the symptoms arc more urgent than what can be accounted for 
upon the supposition of a stricture or disease of the prostate gland, a 
stone is to he suspected 



168 SUPPOSED CONSEQUENCES CHAP. IX. 



SECTION I. 

Of tlie Treatment where the Actions of the Urethra and Bladder do 
not exactly alternate. 

The cure, where the disease arises from spasm alone, consists in 
removing the disposition to over-action in the urethra, and the irrita- 
ble disposition of the bladder when the urethra does not obey it. 
Perhaps opiate clysters, as a temporary means of relief, are the very 
best medicines that can be administered. I have known a blister to 
the loins, or to the perinamm, remove the spasm, in a great measure, 
from the urethra. 

When the circumstance of the ultimate actions of these parts not 
being regular arises from the stricture, swelled prostate gland, or any 
mechanical obstruction to the urine, then that cause must be re- 
moved, as has been fully described in the treatment of these dis- 
eases. 



SECTION II. 

Of the Paralysis of the Bladder from Obstruction to the Passage of 

the. Urine. 

We may observe that the bladder is a part easily deprived of its 
power of contraction; for we find in many debilitating diseases and 
long illnesses from any cause, as fever, gout, and considerable local 
diseases which debilitate, that the bladder often becomes paralytic, 
and the water must be drawn off. We may also observe, when the 
bladder has been distended considerably, from whatever cause, so as 
to have its contractile power destroyed, that there is a considerable 
extravasation of blood from the inner surface of the bladder, so that 
the water which is evacuated is often extremely bloody. I have seer.. 
in cases where the patient has died with this obstruction upon him, 
that the inner membrane of the bladder has been almost black, being 
loaded with extravasated blood; but this symptom of bloody urine 
goes off as the bladder acquires again its power of action. 

In the diseases of the urethra, before described, when not pro- 
perly, or in time, attended to, and in cases of stricture, where na- 
ture has not been able to relieve herself, the water must of course be 
retained in the bladder, which is perhaps always productive of an- 
other disease, that is, the loss of the power of contraction of that 



SECT. II. OP GONORRHOEA. 169 

viscus. Although this one effect, the retention of urine, arises from 
•very different causes, as before related, yet immediate relief must be 
given in all of them, which can only be effected by the evacuation of 
the water. According to the nature of the obstruction, the mode of 
evacuation will be different, and will be of two kinds, one by the na- 
tural passage by means of an hollow tube, the other by an artificial 
opening made into the bladder. 

If the causes of suppression are either spasmodic affections of the 
urethra, a swelled prostate gland, inflammation in the surrounding 
parts of the urethra, or tumors pressing upon it, as happens in preg- 
nant women, immediate relief may be procured by meuns of a ca- 
theter, because under such circumstances a catheter will most proba- 
bly pass, the sides of the canal being merely forced together by 
spasm, or external pressure. 

A bougie, although it will also pass under such circumstances, 
will not answer so well, because a bougie must be withdrawn before 
the water can flow, which will allow the cause of the obstruction to 
exert against its full force; and if the spasm should not now e::ist, 
yet the bougie will not answer, unless there be a power of action in 
the bladder; for it is with difficulty that the urine can be made to 
pass through the urethra, by pressing the abdomen only. 

When the catheter is passed, it will be necessary to make the pa- 
tient strain with his abdominal muscles, as also with his muscles of 
respiration, to squeeze out the water, the bladder having no power of 
contraction; and even this will not be sufficient, for it will be neces- 
sary to press on the region of the pubes, with the hand, to make the 
water flow. 

In cases where there is a considerable degree of debility in the 
bladder, or in those cases where there is a considerable strangury and 
of long standing, and where a small quantity of urine in the bladder 
gives a stimulus of fulness to that viscus, which is always attended 
with considerable urgency to make water; and where only very 
small quantities are evacuated, the bladder not being emptied at 
each time of making it, and when a catheter, either rigid or flexi- 
ble, can with readiness be passed, the question is, what is the best 
way upon the whole to evacuate the water? There are three ways in 
which it can be done, one, by allowing the parts to do their own bu- 
siness as much as they can, and this at first sight might be supposed 
to be the very best; but it is in some cases the very worst; for the 
frequency of the inclination to make water, arising from the water 
not being wholly evacuated each time, the evacuation not readily 
taking place, increases the effort, and for a few minutes produces 
excruciating pain, keeping up a considerable and almost constant ir- 
ritation in all those parts, which few can bear. Another method is, 
to draw off the water each time with a catheter, but this in many 
cases is next to impracticable; for supposing the operation to be per- 
formed only twice or three times in the day. Ave shall find that this is? 

T 



170 SUPPOSED CONSEQUENCES CHAP. IX. 

oftener than what should be clone. The third method is, to leave the 
catheter almost constantly in the bladder. 

Which of these three methods is likely to give, on the whole, the 
least irritation must depend upon circumstances attending different 
cases. Where the frequency and the urgency is great, and the flow- 
ing of the water difficult, either the second or the third is to be pur- 
sued; and when the symptoms are such that a catheter must be pass- 
ed very often, I believe it had better be left in, only taking it out oc- 
casionally. I think this is supported by observation and experi- 
ence. 

It sometimes happens, in cases of swelled prostate gland, that the 
catheter cannot be passed without the utmost difficulty; and when this 
has been the case, I have left it in the bladder, for fear of not being 
able to pass it again, and continued it there till the bladder has suffi- 
ciently recovered its tone, which is known by its being able to throw 
the urine through the catheter; after which that instrument may be 
withdrawn. 

if the spasm, in such cases as arise from that cause, should still 
continue after the bladder has recovered its tone, w r e must continue 
the use of the catheter. But it often happens that the spasm leaves 
the urethra before the bladder recovers its power of contraction, the 
disease becoming then simply a paralysis of that viscus. 

One of the first symptoms of the bladder beginning to regain its 
power of contraction is, the sensation of fulness, or an inclination to 
make water; and when that sensation comes on, the patient should 
be allowed to make water, but not to force it, for that circumstance 
alone will bring on the spasm, if the urethra is not very ready to di- 
late. I have seen, however, in some cases, that a slight sensation is 
not altogether to be depended upon, for it required a little retention 
more effectually to stimulate the bladder to action, and then the water 
has passed more freely. 

The spasmodic contraction of the urethra does not appear to give 
up its action simply upon the stimulus or inclination to make water, 
and not till the bladder begins to have the power of contraction; for 
in cases where the bladder is paralytic, and yet sensible of the stimu- 
lus arising from being full, as it does not contract, the urethra does 
not relax, and the water cannot be made to pass. 

It would appear, that, as the bladder recovers of the paralysis, it is 
not able to contain so much water as usual. Therefore the patients 
are obliged to make water often, and of course in small quantities. 



SECT. III. OF GONORRH(EA. 171 



SECTION III. 

Of the Cure of the Paralysis of the Bladder, from Obstruction arising 
from Pressure or Spasm. 

The removal of the causes of the paralysis of the bladder was 
fully described when we were treating of the diseases which produce 
that complaint, and the immediate relief, when the bladder is ren- 
dered inactive, has just now been considered; the paralysis itself ia 
therefore the only remaining thing to be attended to. In this disease 
ihere are often contrary indications of cure, for a spasm is very dif- 
ferent from a paralysis; and if the suppression is from spasm, and 
that still continues, then what may be good for the paralysis may 
be bad for the spasm. As in such cases the water can be drawn off, 
the bladder should be first attended to. Stimulants and strengthen- 
ers are useful; blisters to the loins to rouse the bladder to action, and 
blisters to the perinasum,to take off the spasm from the urethra, often 
succeed. Electricity is sometimes of singular service, when ap- 
plied in such cases to the perinaeum. Through the whole of the 
cure the urine must be drawn off frequently, because the bladder 
should not be allowed to be distended, which otherwise would be the 
consequence; and the sensation arising from the distention of that 
viscus is a very oppressive one. 

A gentleman was at times attacked with a difficulty in making 
water, which he paid no attention to, as it had always gone off; but 
at last he was obliged to have recourse to the catheter, which afforded 
only a temporary relief. The spasm continued, and 1 was sent for. 
When I passed the catheter, I was obliged to press the lower part of 
the abdomen to squeeze out the water, for the bladder appeared to 
give but little assistance. I ordered a blister to the loins, which 
gave some power of contraction to the bladder, and took off some of 
the spasm in the urethra, but still he was very little relieved. I then 
directed a blister to be applied to the perinaeum, which immediately 
removed his complaint. 



172 SUPPOSED CONSEQUENCES CHAP. X. 

CHAP. X. 

Of a Suppression of Urine — and Operations for the Cure of it. 

In cases of total suppression of urine, arising from strictures, or 
other causes where a catheter cannot be passed, and where every 
other method recommended is impracticable, an artificial opening 
must be made into the bladder for the evacuation of the water. 
There are three places where this opening may be made, and each 
has had its advocates. This operation has not been considered in all 
its circumstances in different patients, so as to direct the young sur- 
geon in the variety of cases that may occur; for under some circum- 
stances the operation is more advisable in one place than another; 
and indeed it may sometimes be next to impossible to perform it in a 
particular part. 

The opening may be made first in the perinagum, where we now 
cut for a stone; secondly, above the pubes, where cutting for the 
stone was formerly practised; and thirdly, from within the rectum, 
where the bladder lies in contact with the gut. 

The first question, which naturally occurs, is, which of those situ- 
ations is the most proper for the safety of the patient, the evacua- 
tion of the water, and the conveniency of operating, when no parti- 
cular circumstance forbids either of the situations? 

On the first view of the subject, one would be apt to prefer that 
above the pubes, or from the rectum, as the bladder is nearer to either, 
and the parts more adapted to an operation than from the perinaeum, 
where we must cut at random. These two situations, although the 
most proper in this respect, under certain circumstances, yet may 
become the most improper; for they are subject to greater changes 
than the perinaeum. 

The reasons thai may render it very improper above the pubes 
are, the persons being very fat, or the bladders not distending suffi- 
ciently so as to rise above the pubes, which is common enough in 
diseases of those parts. 

In very fat people it will be found that the substance to be cut 
through may be three or four inches, which will not only make the 
operation very unpleasant, but often improper; for such thickness of 
parts will make the swell of the bladder very obscure and uncertain; 
in many the bladder is so diseased as to allow of but little distention, 
and in such the symptoms of fulness come on very early, perhaps 
when there is only a few ounces of water collected. But if the re- 
tention has been for some considerable time, as twenty-four hours, then 
we may suppose that the bladder has allowed of distention to a much 
greater degree, which may in some cases be ascertained by introduc- 
ing the finger into the rectum. 



CHAP. X. OF GONORRHOEA. 173 

But where the bladder distends, and the parts are so thin that it 
can bo plainly felt above the pubes, I see no material objection to 
this situation; and it has this advantage over the operation by the 
rectum, that a catheter can more easily be introduced, and kept in, 
which will be necessary to be done till the cause is removed. 

It may be necessary here to mention some precautions respecting 
the keeping the instrument in the bladder; as also the best kind to 
be used, it must be an hallow tube; and should reach as far as the 
posterior surface of the bladder, for upon the contraction of that vis- 
cus its anterior part recedes backwards and downwards from the ab- 
domen towards its fixed point, which may draw the bladder off from 
the tube. But as the distance between the skin of the abdomen and 
posterior surface of the bladder cannot be exactly ascertained, the 
cannula may be either too long, or too short; if too long, its end may 
press upon the posterior surface of the bladder, and produce ulcera- 
tion there, and in time work its way into the rectum. To avoid this 
mischief, as also the inconveniences arising from its being too short, 
and the bladder slipping off from its end, I would recommend the 
tube to be made with a curve, and to lie with its convex side on the 
posterior part of the bladder, which being a large surface, and fol- 
lowing nearly the same curve as the cannula, less mischief is to be 
expected. The openings into the cannula may be made on the con- 
cave side. 

It would probably be both safer and easier for the patient to have 
the curved end of the catheter introduced into the urethra from the 
bladder. The passing of it into the urethra is very practicable; and 
we know that such a body lying in the urethra is not productive of 
any mischief. A common catheter, passed in this way, enters so 
far as to bring the handle almost flat to the belly, at most only a lit- 
tle bolster between the catheter and belly is necessary, and then with 
a piece of tape fixed to the handle of the catheter it might be fast- 
ened to the body; or a short catheter might be made with ears to fix 
the tape to.* In cases where the cannula has remained in the ure- 
thra for some time, the artificial passage will become in some de- 
gree permanent, so that it may be taken out occasionally, and clean- 
ed from any stony matter that may be attached to it. To avoid this 
part of the operation, it has been recommended to have two cannu- 
las, one within the other, that by drawing out the inner it may be 
cleaned, and again introduced; but in most cases it will also be ne- 
cessary to withdraw the outer one, as its external surface will con- 
tract a crust. 

* Where this operation is performed in consequence of a stricture, T have con- 
ceived that, bypassing a catheter into the urethra from the bladder till it comes 
to the stricture, and then passing another straight cannula from the glansdown 
the urethra, that the two may nearly meet, only having the stricture between 
them; and a piercer may be passed" down and forced into the end of the one 
from the bladder, and afterwards either a bougie or hollow catheter introduced 



1?4 SUPPOSED CONSEQUENCES CHAP. X. 

The second method, or puncture by the anus, will more common- 
ly admit of being performed than that above the pubes; for it does 
not require that distention of bladder which the other does, there- 
fore not so often impracticable from that cause; and perhaps the only 
obstacle here is a swelled prostate gland. In many of these cases of 
diseases of the urethra the prostate gland is very much swelled, 
which I can conceive may make the proper place for the puncture 
very uncertain; for the prostate gland, in such cases, will be pressed 
down towards the anus, before the bladder, and will be the first thing 
felt by the finger. Care must therefore be taken to distinguish the 
one from the other, which can only be done by getting the finger be- 
yond the prostate gland, which may not be practicable; and if prac- 
ticable, it may not be an easy matter to distinguish the one from the 
other, as a thickened and distended bladder may seem to be a con- 
tinuation of the same tumor. However, if the objections given to 
the performing it above the pubes exist, 1 should prefer operating by 
the rectum; for although the probability of succeeding here may not 
be apparently greater than above the pubes, yet the chances are in 
its favour. 

I must, however, observe here, that the objections which I have 
started, are only raised in my own mind from my knowledge of the 
diseases of those parts, and not from cases of suppression of urine un- 
der all the before-mentioned circumstances having occurred to me in 
practice. 

A case of a total suppression of urine arising from stricture, where 
no instrument could be passed by the natural passage, and where a 
puncture was made into the bladder, from the rectum, with success, 
is related in the Philosophical Transactions, by Dr. Hamilton, of 
King's Lvnn, in Norfolk.* 

What led Dr. Hamilton to do it here was, a difficulty which was 
found in passing the clyster-pipe into the rectum, which induced him 
to introduce his finger into the anus, and he found the bladder so 
prominent in the rectum as to give the hint of performing the opera- 
tion there. 

The man was put into the same position as in the operation 
for the stone, and a trochar was introduced upon the finger into the 
anus, and thrust into the lower and most prominent part of the 
tumor, in the direction of the axis of the bladder, and upon with- 
drawing the piercer, the water flowed out through the cannula. 

A straight catheter was then introduced through the cannula, lest 
the orifice in the bladder should be drawn off from the cannula. 

Then the cannula was pulled out over the catheter, which was left 
in till the whole water was evacuated, and was then withdrawn. 

The bladder, notwithstanding this perforation, retained the water 
as usual, till the inclination to make it came on; and when he per- 

* Philosophical Transactions for the ycai 1776, vol. 66, page 578. 



CHAP. X. OF GONORRHOEA. 175 

formed the action of making water, the orifice in the bladder seemed 
to open, and it rushed out by the anus. This continued about two 
days, when the water began to find its natural passage, and a bougie 
was introduced into the bladder through the urethra, which gave a 
free passage for the water, and of course less came by the anus; so 
that on the sixth day after the operation the whole came by the na- 
tural passage. The man continued the use of the bougie till the 
stricture was dilated. Dr. Hamilton further remarks, that in those 
cases of suppression of urine, in general, he has found that calomel 
and opium, in large doses, answer better than anything he has tried. 
He is convinced, from repeated trials, that the specific efficacy is in 
the calomel, as large doses of opium alone have proved ineffectual; 
but he does not say that calomel alone will answer. He orders ten 
grains of calomel, with tw r o of opium, to be repeated in six hours, if 
it has not answered in that time; and he says he has seldom been 
obliged to give a third dose. 

This method of tapping the bladder was first suggested by Mons. 
Fleurant, surgeon to the Charite, at Lyons, in the year 1150. The 
operation w r as performed at that time, and an account of it was after- 
wards published by Mons. Pouteau, in 1760, with the history of 
three cases, in all which the operation was performed by Mons. 
Fleurant. The propriety of performing the operation in this part 
occurred to him in a manner similar to that before related of Dr. 
Hamilton; for, in introducing the finger into the rectum to examine 
the state of the bladder, in a case where he was going to puncture in 
the perinacum, he found the bladder so prominent there, and so much 
within the reach of his instrument, that he immediately altered his 
intention, and performed it in this part. He very readily drew oft' 
the water, and kept the cannula in with a T bandage, till the urine 
came the right way, and then withdrew it, and all terminated well. 
But there was a good deal of trouble, on account of the cannula being 
left in, on going to stool, as also from the constant dribbling of the 
water through it, all of which was prevented in Dr. Hamilton's case, 
by removing the cannula immediately upon the evacuation of the 
water. This was productive of another good effect, which was the 
retention of the urine till the stimulus of fulness was given, and then 
it passed through the artificial as it would through a natural passage. 
Should this be a constant effect in consequence of performing the 
operation here, I think it must be owned to be an unexpected circum- 
stance which at first could not have been imagined/- 

In another patient of Mons. Fleurant's, the cannula was kept in the 
anus and bladder thirty-nine days, without any inconveniency; so 
that the objection to this part of the operation cannot be material. 
Pouteau mentions one case where he performed this operation, in the 

* A history, with a description of this operation, is published by Mr. Eeid, 
surgeon, of Chelsea, in 1778. 



17t) SUPPOSED CONSEQUENCES* CHAP. X. 

year 1752, and the man died * He says, I was called to visit a poor 
man suffering under a retention of urine, so obstinate and violent that 
it had already the symptoms of what is called a reflux of urine into 
the blood; and the complaint had continued more than three days. 
An empiric, to whose care he had been entrusted, after having very 
improperly given him the most powerful diuretics, had likewise the 
rashness to search him. It appears probable, that these attempts, 
which were made without success, must have increased the mischief. 
A catheter could not be passed into such parts by unskilful hands, 
without increasing the inflammation. I only made three slight efforts 
to effect a passage into the bladder by the urethra, which appeared to 
be much diseased, as well by the effusion of blood, as the extreme 
pain which these attempts produced. I determined at once to do as 
before, and plunged my trochar by the rectum into the bladder. The 
success was exactly the same; the bladder was entirely emptied, and 
I allowed the cannula to remain there a whole night and a day, during 
which time the urine flowed without intermission. Every thing went 
on without any accident which could be supposed connected with 
the operation; and death, which happened next day, was entirely in- 
dependent of it. 

One must suppose with Pouteau, that the death of the patient 
could not have arisen from this operation, but from the preceding- 
diseases. 

The bags called vesiculae seminales, and the haemorrhoidal ves- 
sels, have been mentioned as parts in danger of being wounded in the 
operation, and thereby proving troublesome; but if either of them are 
wounded, no inconvenience can arise. To avoid the vesiculae semi- 
nales, it is recommended to perforate high up, and directly in the 
middle of the bladder, between the two sides; and this situation, 
is, at the same time, the one where the haemorrhoidal vessels 
are the smallest, and therefore it is of less consequence if they 
are wounded. 

It must appear from the following case, sent me by a gentle- 
man, that a communication being kept up between the bladder 
and rectum is only inconvenient, and not so much so as might 
be expected. 

" With respect to the sailor who passed his urine by the rectum, 
I have examined the few papers by me, but cannot find the particular 
remarks I made; however, as the case was singular, I recollect the 
man told me, that a few years before, (this was at Madras hospital, 
in December 1779,) he had the venereal disease very bad, and long; 
that the urine came by the anus, but this passage healed up, and it 
came by the penis, and continued to do so till he caught the disease 
again, when the urine found its way a second time by the anus, and 

• Pouteau Melanges de Chirurgie, printed at Lyons, 1760, page 506, 507, 
and 508. 



'HAP. X. OP GONORPJNEA. Vll 

came that way for years. When be first came under my care, in 
the hospital at Bombay, February 1779, he felt no uneasiness or in- 
convenience from this manner of passing his urine; whenever he had 
an inclination to make water he sat down. I often made him lie upon 
his breast, with his legs drawn up, and the stream came through the 
anus with great force." 

In other cases, in consequence of abscesses forming between the 
bladder and rectum, where they have not healed up, there has been, 
a reciprocal passing of the contents of these cavities from the one to 
the other. 

It only remains to speak of the puncture in the perinaeum. An 
obstruction to the urine taking place in the natural passage prevents 
us from introducing an instrument in most of those cases, and de- 
prives us of all the advantages we could receive from it as a guide 
in the operation; yet there may be cases of stricture, where, by cut- 
ting into the urethra, beyond the stricture, the water will flow; but 
this must be done without any guide or direction, and requires a nice 
and accurate knowledge of the parts; or if the obstruction arises from 
the valvular projection of the prostate gland, a staff may be passed 
as for as this projection, and cut upon as for the stone, the surgeon 
only making a small incision, using a small gorget, or, in the room 
of that, atrochar of a particular form might be run along it into the 
i;la;lder; for although the staff does not enter the bladder, yet the 
distance to pass through without this guide is but small. If this can- 
not be done, a small and deep incision must be made in the peri- 
neum, with an imposthume lancet, towards the bladder; the point of 
the trochar is to be introduced by this, the surgeon passing at the 
same time the fore-finger of the other hand into the anus, which will 
be a guide both for the direction of the instrument, as also to avoid 
itspoi.-t passing into the rectum. With these precautions the error 
cannot be great. 

I must own, however, that I have not seen cases enough to enable 
me to give all the varieties that commonly happen, and of course to 
qrivc all the advantages and disadvantages of each method. 



In the foregoing passages of this chapter, it is impossible not to ad- 
mire the modesty, diligence, and caution of Mr. Hunter. Another 
thing is not less remarkable. It has been often said, not only that 
Mr. Hunter read nothing, but that he undervalued medical reading. 
That be read little cannot be wondered at, in one who worked so 
much: perhaps it may be said that he rarely, if ever, depended on 
the experiments recorded by others, when he wished to establish his 
own doctrines. The present, however, with many other passages in 
the l - Treatise," shows that he thought it his duty to know what had 
been done by others before he offered his own sentiments; and we 
alu,, j find him doing ample justice to bis predecesrow, I mention— 

7- \ 



178 SUPPOSED CONSEQUENCES CHAP. X- 

this, not only to vindicate Mr. Hunter from the charge of undervaluing 
the labours of others, but also to check a certain affectation, which 
at one time too generally prevailed, of the inutility of medical reading. 



SECTION L 

Of allowing a Catheter to remain in the Urethra and Bladder. 

In cases of debility of the bladder, and where a catheter passes 
with difficulty, or with great uncertainty, and in cases where it must 
be used frequently, and for a length of time, it will be necessary to 
keep an instrument in the urethra and bladder, so as to allow the 
water to pass through it freely. A common catheter, or one made 
of the elastic gum, is perhaps the best instrument; but it must be 
fixed in the canal; this will be best done by its outer end being tied 
to some external body, as I shall now describe. When the catheter 
is fairly in the bladder, the outer end is rather inclined downwards, 
nearly in a line with the body. To keep it in this position, we may 
take the common strap or belt-part of a bag-truss, with two thigh- 
straps either fixed to it or hooked to it, and coming round each thigh 
forwards by the side of the scrotum, to be fastened to the belt where 
the ears of the bag are usually fixed. A small ring or two may be 
fixed to each strap just where it passes the scrotum or root of the 
penis; and with apiece of small tape the ends of the catheter may 
be fixed to those rings, which will keep it in the bladder. A bit of 
rag, about four or five inches long, with a hole at the end of it^ pass- 
ed over the exterior end of the catheter, and the loose end allowed 
to hang in a basin, placed between the thighs, will catch the water 
which cannot disengage itself from the catheter, and keep the patient 
dry; or if another curved pipe is introduced into the catheter, it will 
answer the same purpose. 

Under such treatment the bladder will never be allowed to be dis- . 
tended; and when the patient wants to have the bladder in some de- 
gree emptied, he has only to strain with his abdominal muscles, by 
which means he will be able to throw out a great deal at. each time. 

As the bladder begins to recover its actions, the patient will find 
that an inclination to make water will come on, and at those times 
he will also find that the water will come from him without straining 
with the abdominal muscles; when this takes place readily, the ca- 
theter may be taken out, and it will be found that he will be able 
in future to make water of himself. If it is necessary to keep in the 
catheter a considerable time, it will be the cause of a good deal of 
slime and mucus being formed in the urethra and bladder; but I be- 



SECT II. OF GONORRHOEA. 179 

lieve this is of no consequence. I have known a catheter kept in 
this way for five months without any inconveniency whatever. 

In all cases where it is necessary to keep an extraneous body for 
a considerable time in the bladder, whether in an artificial passage or 
the natural one, it will be proper a few days after its first introduction 
to withdraw it and examine whether it is incrusting, or filling up in 
its cavity with the calculous matter of the urine. If, after remaining 
in the bladder for some days, it has contracted none, we need be un- 
der no apprehensions of its doing it; but if, as frequently happens, it 
should have collected a considerable quantity, then it will be neces- 
sary to have it occasionally withdrawn and cleaned. The best me- 
thod probably of doing this is to put it in vinegar, which will soon 
dissolve the stony matter. 



SECTION II. 

Of the increased Strength of the Bladder. 

The bladder, in such cases as have been described, having more 
to do than common, is almost in a constant state of irritation and ac- 
tion; by which, according to a property in all muscles, it becomes 
stronger and stronger in its muscular coats; and I suspect, that this 
disposition to become stronger from repeated action, is greater in the 
involuntary muscles than the voluntary; and the reason why it should 
be so is, I think, very evident; for in the involuntary muscles the 
•lower should be, in all cases, capable of overcoming the resistance, 
;ts the power is always performing some natural and necessary ac- 
tion; for whenever a disease produces an uncommon resistance' in 
the involuntary parts, if the power is not proportionally increased, 
the disease becomes very formidable; whereas, in the voluntary 
muscles, there is not that necessity, because the will can stop when- 
ever the muscles cannot follow; and if the will is so diseased as not 
to stop, the power in voluntary muscles should not increase in pro- 
portion. 

I have seen the muscular coats of the bladder near halt an inch 
thick, and the fasciculi so strong as to form ridges on the inside of 
that cavity;* and I have also seen the fasciculi very thin, and even 
wanting in'some parts of the bladder, so that a hernia of the internal 

• This appearance was lon S supposed to have arisen from a disease of that 

viscus; but upon examination I found that the muscular parts were sound and 

istmct- that they were only increased in bulk in proportion to the power they 

had to exert; and that it was not a consequence oi inflammation, tor in that 

case parta are blended into one indistinct mass. 



180 SUPPOSED CONSEQUENCES CHAP. X. 

coat had taken place between the fasciculi, and formed pouches.* 
These pouches arise from the thin parts not being able to support 
the actions of the strong; as happens in ruptures at the navel, or 
rings of the abdomen. 



SECTION III. 

Of the Distention of the Ureters. 

It sometimes happens that the irritation from the distention oi 
the bladder, and the difficulty in throwing out its contents, is so 
great, that the urine is prevented from flowing freely into that viscus 
from the ureters, which become thereby preternaturally distended. 
The pelvis of the kidneys and infundibula are also enlarged; but 
how far this dilatation of the ureters and pelvis is really owing to a 
mechanical cause I am not so clear; or whether it is not a disposi- 
tion for dilatation arising out of the stimulus given by the bladder. 
In some cases of long standing, where the bladder was become very 
thick, and had been for a long time acting with great violence, it 
had affected the mamillae, so that the surface of these processes pro- 
duced a matter, and perhaps even the secreting organs of the kid- 
neys, so that the urine secreted was accompanied with a pus, arising 
from the irritation being kept up in all these parts. 

The urine in the above cases is generally stale, even before it is 
thrown out of the bladder, which, when joined with the circumstance 
of the linen being constantly kept wet, by the almost continual dis- 
charge of urine, becomes very offensive, and it is hardly possible to 
keep the patient sweet. 



SECTION IV. 

Of Irritability in the Bladder independent of Obstructions to the 
Passage of the Urine. 

Another disease of the bladder, connected with that present sub- 
ject, is, where that viscus becomes extremely irritable, and will not 

• * T u S j? P erha P 8 t,ie cause of l, >e stone being often found in a pouch formed 
m the bladder ; for the bladder, in cases of stone, is often very strong-, which 
arises from the violent contraction of that viscus, caused by the irritation of the 
stone on the sides of it; and also from the stone being often opposed to the 
mouth oi the urethra in the time of making water. 



sttCT. V. OF GONORRHEA. 181 

allow of its usual distention. The symptoms of this disease are very 
.similar to those arising from obstructions to the passage of the urine 
in the urethra, but with this difference, that in the present disease the 
urine flows readily, because the urethra obeys the summons and re- 
laxes; however, there is often considerable straining after the water 
is all voided, arising from the muscular coat of the bladder still con- 
tinuing its contractions. 

This irritability of the bladder often arises from local causes, as a 
stone, cancer, or tumors forming on the inside, all which produce ir- 
ritability of this viscus. In such cases the straining is violent, for 
the cause still remains which continues to give the stimulus of some- 
thing to be expelled, and the bladder continues to contract till tired, 
as in the cases of simple irritability; and then there is a respite for 
a time; but this respite is of short duration, for the urine is soon ac- 
cumulated. 

This disease will in the end be fatal by producing an hectic fever. 



SECTION V. 

Of the Cure of Simple Irritability of the Bladder. 

When the symptoms arise from irritability alone, and not from a 
stone, or any local affection, the nature of the complaint may not at 
first be so obvious; temporary relief may, however, be procured by 
opium, which is most effectual in slight and recent cases; and if it 
be applied as near to the part as possible, its effects will be more evi- 
dent; and therefore it may be given by clyster as well as by the 
mouth. 

I should, however, be inclined to rely on a blister applied to the pe- 
rineum, or to the lower part of the small of the back, or upper 
part of the sacrum, if more convenient, than to any other method of 
cure. 

In all cases where there is an irritation of the bladder the patient 
should never endeavour to retain his water beyond the inclination to 
make it. It hurts the bladder and increases its irritability; and in- 
deed I am apt to think that this circumstance, even in sound parts, is 
often a predisposing cause of disease in this viscus and its appendage, 
the urethra; for I have known several cases where it has brought on 
the spasmodic stricture in the urethra, in sound parts; and it is fre- 
quently an immediate cause of strangury in those who have either a 
stricture, or a disposition to spasms in those parts. 

A gentleman, in perfect health, from retaining his urine beyond 



182 SUPPOSED CONSEQUENCES CHAP. XI. 

the inclination, in the playhouse, had all the symptoms of an irrita- 
ble bladder brought on, which continued for several years, render- 
ing him miserable. 



SECTION VI. 

Of a Paralysis of the Acceleratores Urince. 

Im many irritations of the bladder, the urethra not only relaxes di- 
rectly on the stimulus to make water being felt in that yiscus, as has 
been described; but a paralysis sometimes takes place in the volun- 
tary muscles of those parts, so that the will cannot command them to 
contract to hinder the inconveniences that may attend an immediate 
evacuation of that fluid. If we attempt to stop the water, which is 
an act of the will, it is in vain; the acceleratores will not obey, and 
the water flows. 

A blister applied to the perineum will have considerable effects in 
removing this complaint. 



CHAP. XI. 



Of the Discharge of the Natural Mucus of the Glands of the Ure- 
thra. 

The small glands of the urethra, and Cowper's glands, se- 
crete a slimy mucus, similar to the white of an egg not coagulated. 
This seldom appears externally, or flows from the urethra, but during 
the indulgence of lascivious thoughts, and is seldom or never attend- 
ed to, excepting by those who are under apprehensions either of a go- 
norrhoea coming on, or imagine the last infection is not gone off en- 
tirely, and are therefore kept in constant terror by this natural dis- 
charge. They often find it in such quantity as to leave spots on the 
shirt, but without colour; and often, after toying, the lips of the ure- 
thra are as it were glued together by it, from its drying there, which 
appearances alarm the mind of the patient without cause. Although 
this is only a natural discharge, and is secreted at such times, under 
the same influence which naturally produces it, it must be owned, 
that it is commonly much increased in those cases of debility arising 
from the mind, which is probably not easily to be accounted for. It 



* ECT - '• OP GONORRHOEA. 183 

would seem that the contest between the mind and die body increases 
this secretion, for it cannot be considered as a disease of the parts. 

The whole of this and the following chapter is peculiarly impor- 
tant, the diseases noticed in them are those which are the principal 
harvest of designing quacks, and the sources of the most dreadful un- 
easiness to many young men. Yet, to deprive them of both, it is 
only necessary that the true causes should be understood. There is 
nothing more serious in a greater discharge from these parts, than a 
weeping eye, or a too frequent discharge from the nose. Nor is it 
less true that the bare apprehension of such an event will increase 
such discharge in all those parts. 



SECTION I. 

Of the Discharge of the Secretions of the Prostate Gland and Vesi- 
siculxe Seminales. 

This complaint is imagined to be the consequence of the venereal 
disease in the urethra: but how far this is really the case is not cer- 
tain; though most probably it is not. It is a discharge of mucus 
by the urethra, which generally comes away with the last drops of 
urine, especially if the bladder is irritable; and still more at the time 
of being at stool, particularly if the patient be costive; for, under 
such circumstances, the straining or actions of the muscles of those 
parts are more violent. It has generally been supposed that this dis- 
charge is semen; and the disease is called a seminal weakness; but 
it appears, from many experiments and observations, that the dis- 
charge is undoubtedly not semen. It is only the mucus secreted 
either by the prostate gland, by those bags improperly called vesicular 
seminales, or both; and it may not be improper to give here the dis- 
tinguishing marks between these two fluids. First, we may observe 
the discharge in question is not of the same colour with the semen, 
and is exactly of the colour of the mucus of the prostate gland, and 
of those bags. It has not the same smell, and indeed it hardly has 
any smell at all. The quantity, evacuated at one time, is often much 
more considerable than the evacuation of semen ever is; and it hap- 
pens more frequently than it could possibly do, were the discharge 
semen. It is a disease that often attacks old men, where one can 
hardly suppose much semen to be secreted; and we find that those 
who are affected with this disease are no more deficient in the secre- 
tion and evacuation of the semen, in the natural way, than bt 



184 SUPPOSED CONSEQUENCES CHAP. XI. 

they had the disease. If the mind be at ease, this shall take place 
immediately after a discharge of semen, as well as before, which 
could not be the case, Avere it semen. Further, if those that labour 
under this complaint are not connected with women, they are as sub- 
ject to nocturnal discharges from the imagination as persons who 
are perfectly sound; and indeed most patients, when made acquaint- 
ed with these circumstances, become very sensible that it is not the 
semen. 

It is not clear what the diseased state of the parts is upon which 
this discharge depends, whether there is a larger secretion of this mu- 
cus than natural, or whether it is entirely owing to a preternatural, 
uncommon action of those parts; and if this last, why these parts 
should be put into action when the bladder, rectum, and abdominal 
muscles, are thrown into action to expel their contents, is not easily 
explained. It is plain that the most violent actions of these parts 
are necessary to produce this evacuation; for it does not come with 
the first of the urine, nor, in general, with an easy stool. 

As it was thought to be a seminal discharge, it was imagined to 
arise from a weakness in the organs of generation; and as frequent 
discharges of the semen in the natural way generally weaken, it was 
therefore imagined that this discharge must also weaken very consi- 
derably; and the imagination will operate so strongly as to make the 
patients believe they really arc weakened. Whether the cause of 
such a discharge is capable of weakening, I will not pretend to say; 
but I believe that the discharge simply does not. Fear and anxiety 
of mind may really weaken the patient. In the cases I have seen of 
this kind, the mind has been more affected than the body. 

From my own practice, I can hardly recommend any one medi- 
cine, or way of life, for removing this complaint. In one case 1 
found considerable benefit from giving hemlock internally. 

The idea that has been formed of the disease leads to the prac- 
tice generally recommended, such as giving strengthening medicines 
of all kinds; but I never saw any good effects from any of them; and 
I should rather be inclined to take up the soothing plan to prevent all 
violent actions. Keeping the body gently open will in some de- 
gree moderate the discharge, and probably may effect a cure in the 
end. 



In all these cases, the principal means of cure, as far as a cure 
can be expected, is to impress the patient with a proper sense of the 
disease; as far, I say, as they can be cured, because it often happens 
that such increased discharge depends on a peculiarity of constitution. 
But if the patient is perpetually examining the mouth of the urethra, 
or wiping his eye or his nose, such irritations applied to parts pre- 
disposed to over-secretion must increase such a habit. The sympa- 
thy with the mind is not less certain, though I pretend not to account 



ECT - l - OF GONORRHtEA. 185 

for the reason. The first means of cure is, therefore, if possible, to 
divert the mind from so frequently brooding over these inconve- 
niences. But, besides this, it is often necessary also to administer 
local or internal remedies, in order to increase the patient's confi- 
dence in his amendment, and to prevent his application to dangerous 
and unfeeling impostors. 



CHAP. XIT. 

Of Impotence. 



This complaint is by many laid to the charge of Onanism at an 
early age; but how far this is just, it will in many cases be difficult 
to determine; for, upon a strict review of this subject, it appears to 
me to be by far too rare to originate from a practice so general. 

How far the attributing to this practice such a consequence is of 
public utility, I am doubtful, particularly as it is followed most com- 
monly at an age when consequences are not sufficiently attended to, 
even in things less gratifying to the senses; but this I can say with 
certainty, that many of those, who are affected with the complaints in 
question, are miserable from this idea; and it is some consolation for 
them to know that it is possible it may arise from other causes. I 
am clear in my own mind, that the books on this subject have dons 
more harm than good. 

In the cases of this kind that have come under my care, although 
the persons themselves have been very ready to suppose that the dis- 
ease has arisen from the cause here alluded to; yet thej T did not ap- 
pear to have given more into the practice than common; and in par- 
ticular, the worst case I have ever seen was where but very little of 
this practice had ever been used, much less than in common among 
boys. 

Nothing hurts the mind of a man so much as the idea of inability 
to perform well the duty of the sex. If his scrotum hangs low it 
makes him miserable; he conceives immediately that he is to be ren- 
dered incapable of performing those acts in which he prides himself 
most. It is certain, the relaxation, or contraction of the scrotum, is 
in some degree a kind of sign of the constitution; but it is of the con- 
stitution at large, not of those parts in particular. Nurses are so sen- 
sible of the contraction of that part being a sign of health in the 
children under their care, that they take notice of it. The relaxation 
of it in them cannot be supposed to arise from inability to perform 
those acts at one time more than another. The face is one of the 
signs of the constitution, and has as much to do with those peculiar 

a a 



186 SUPPOSED CONSEQUENCES CHAP. XII. 

acts as the scrotum. However, we must allow that this part is much 
more lax than what we should conceive was intended by Nature, 
even in young men who are well in health; but as this is very gene- 
ral, I rather suspect that it arises from the circumstances of the part 
being kept too warm, and always suspended, the muscles hardly ever 
being allowed to act, so that they have less force. How far it is the 
same in those countries where the dress does not immediately 
suspend those parts, I have not been able to ascertain. Warmth ap- 
pears to be one cause; for we find that cold has generally an imme- 
diate effect; but this is perhaps owing to its not being accustomed to 
cold, which, if it were, it might possibly become as regardless of as 
it is of warmth. What the difference is in this part, in a cold and 
warm climate, all other circumstances the same, I do not know; but 
whatever may be the cause, if it is really in common more lax than 
intended by Nature, it is of no consequence as to the powers of gene- 
ration. The testicles will secrete whether kept high or low. 



SECTION I. 

Of Impotence depending on the Mind. 

As the parts of generation are not necessary for the existence or 
support of the individual, but have a reference to something else in 
which the mind has a principal concern, a complete action in those 
parts cannot take place without a perfect harmony of body, and of 
mind; that is, there must be both a power of body, and disposition 
of mind; for the mind is subject to a thousand caprices, which affect 
the actions of these parts. 

Copulation is an act of the body, the spring of which is in the mind; 
but it is not volition; and according to the state of the mind so is the 
act performed. To perform this act well, the body should be in 
health, and the mind should be perfectly confident of the powers of 
the body; the mind should be in a state entirely disengaged from every 
thing else; it should have no difficulties, no fears, no apprehensions; 
not even an anxiety to perform the act well; for even this anxiety is a 
state of mind different from what should prevail; there should 
not be even a fear that the mind itself may find a difficulty at the 
time the act should be performed. Perhaps no function of the ma- 
chine depends so much upon the state of the mind as this. 

The will, and reasoning faculty, have nothing to do with this power; 
they are only employed in the act, so far as voluntary parts are 
made use of; and if they ever interfere, which they sometimes do, it 
often produces another state of mind, which destroys that which is 
proper for the performance of the act; it produces a desire, a wish, 



SECT. I. OF G0N0RRHC2A. 187 

a hope, which are all only diffidence and. uncertainty, and create in 
the mind the idea of a possibility of the want of success, which de- 
stroys the proper state of mind, or necessary confidence. 

There is perhaps no act in which a man feels himself more interest- 
ed, or is more anxious to perform well, his pride being engaged in 
some degree, which, if within certain bounds, would produce a de- 
gree of perfection in an act depending upon the will, or an act in vo- 
luntary parts; but when it produces a state of mind contrary to that 
state, on which the perfection of the act depends, a failure must be 
the consequence. 

The body is not only rendered incapable of performing this act, 
by the mind beingr under the above influence, but also by the mind 
being perfectly confident of its power, but conscious of an impropri- 
ety in performing it: this, in many cases, produces a state of mind 
which shall take away all power. A conscientious man has been 
knoivn to lose his powers on finding the woman he was going to be 
connected with, unexpectedly, a virgin. 

Shedding tears arises entirely from the state of the mind, although 
not so much a compound action as the act in question; for none are 
so weak in body that they cannot shed tears; it is not so much a com- 
pound action of the mind and strength of body, joined, as the other act 
is; yet if we are afraid of shedding tears, or are desirous of doing it, 
and that anxiety is kept up through the whole of an affecting scene, 
we certainly shall not shed tears, or at least not so freely as would 
have happened from our natural feelings. 

From this account of the necessity of having the mind independent, 
respecting the act, we must see that it may very often happen that the 
state of mind will be such as not to allow the animal to exert its na- 
tural powers; and every failure increases the evil. We must also 
see, from this state of the case, that this act must be often interrupted; 
and the true cause of this interruption not being known, it will be 
laid to the charge of the body, or want of powers. As these cases 
do not arise from real inability, they are to be carefully distinguished 
from such as do; and perhaps the only way to distinguish them is, to 
examine into the state of mind respecting this act. So trifling often 
is the circumstance which shall produce this inability, depending on 
the mind, that the very desire to please shall have that effect, as in 
making the woman the sole object to be gratified. 

Cases of this kind we see every day; one of which I shall relate 
as an illustration of this subject, and also of the method of cure. 

A gentleman told me that he had lost his virility. After above an 
hour's investigation of the case, I made out the following facts: that he 
had, at unnecessary times, strong erections, which showed that he had 
naturally this power; that the erections were accompanied with desire, 
which are all the natural powers wanted; but that there was still a 
defect somewhere, which I supposed to be from the mind; I inquired, 
if :i!l women were alike to him, his answer was, no; some women he 



188 SUPPOSED CONSEQUENCES CHAP. XII. 

could have connection with as well as ever. This brought the defect, 
whatever it was, into a smaller compass; and it appeared there was 
but one woman that produced this inability; and that it arose from a 
desire to perform the act with this woman well; which desire pro- 
duced in the mind a doubt or fear of the want of success, which was 
the cause of the inability of performing the act. As this arose en- 
tirely from the state of the mind, produced by a particular circum- 
stance, the mind was to be applied to for the cure; and I told him 
that he might be cured, if he could perfectly rely on his own power 
of self-denial. When I explained what I Meant, he told me that he 
could depend upon every act of his will, or ^solution; I then told 
him, if he had a perfect confidence in himself U that respect, that 
he was to go to bed to this woman, but first promise k» himself, that 
he would not have any connection with her for six nights, let his in- 
clinations and powers be what they would; which he engaged to do; 
and also to let me know the result. About a fortnight after he told 
me thai this resolution had produced such a total alteration in the stats 
of his mind, that the power soon took place; for instead of going to 
bed with the fear of inability, he went with fears that he should be 
possessed with too much desire, too much power, so as to become un- 
easy to him, which really happened; for he would have been happy 
to have shortened the time, and when he had once broke the spell, 
the mind and powers went on together; and his mind never return- 
ed to its former slate. 



SECTION II. 

Of Impotence from a want of proper Correspondence between the Ac- 
tions of the different Organs. 

I lately observed, when treating of the diseases of the urethra and 
bladder, that every organ in an animal body without exception, was 
made up of different parts, whose functions, or actions, were totally dif- 
ferent from each other, although all tending to produce one ultimate 
effect. In all such organs, when perfect, there is a succession of 
motions, one naturally arising out of the other, which in the end pro- 
duces the ultimate effect; and an irregularity alone, in these actions, 
will constitute disease, at least will produce very disagreeable effects, 
and often totally frustrate the final intention of the organ. I come 
now to apply this principle to the actions of the testicle and the 
penis; for we find that an irregularity in the actions of these parts 
sometimes happens in men, producing impotence: and something 
similar, probably, may be one cause of barrenness in women. 



SECT. H. OP GONORRtKEA. 189 

In men, the parts subservient to generation may be divided into 
two, the essential, and the accessory. The testicles are the essen- 
tial; the penis, &c. the accessory. As this division arises from their 
uses or actions in health, which exactly correspond with one another, 
a want of exactness in the correspondence, or susceptibility of those 
actions, may also be divided into two: where the actions are reversed, 
the accessory taking place without the first or essential, as in erec- 
tions of the penis, where neither the mind, nor the testicles, are sti- 
mulated to action; and the second is where the testicle performs the 
action of secretion too readily for the penis, which has not a corres- 
ponding erection. The first is called priapism, and the second is 
what ought to be called seminal weakness. 

The mind has considerable effect on the correspondence of the ac- 
tions of these two parts; but it would appear, in many instances, that 
erections of the penis depend more on the state of the mind than 
what the secretion of the semen does; for many have the secretion, 
but not the erection; but in such, the want of erection appears to be 
owing to the mind only. 

Priapism often arises spontaneously, and often from visible irrita- 
tion of the penis, such as the venereal gonorrhoea, especially when 
violent. The sensation of such erections is rather uneasy than plea- 
sant, nor is the sensation of the glans at the time similar to that aris- 
ing from the erections of desire, but more like to the sensation of the 
parts immediately after coition. Such as arise spontaneously are of 
more serious consequence than those from inflammation, as they pro- 
ceed, probably, from causes not curable in themselves, or by any 
known methods. 

The priapism arising from inflammation of the parts, as in a gonor- 
rhoea, is. attended with nearly the same symptoms; but generally the 
sensation is that of pain, proceeding from the inflammation of the 
parts. It may be observed, that what is said of priapism is only ap- 
plicable to it when a disease in itself, and not as a symptom of other 
diseases, which is frequently the case. 

The common practice in the cure of this complaint is to order all 
the nervous and strengthening medicines, such as bark, valerian, 
musk, camphor, and also the cold bath. I have seen good effects 
from the cold bath; but sometimes it does not agree with the consti- 
tution, in which cases I have found the warm bath of service. Opium 
appears to be a specific in many cases; from which circumstance I 
should be apt, upon the whole, to try a soothing plan. 

Seminal weakness, or a secretion and emission of the semen with- 
out erections, is the reverse of a priapism, and is by much the worst 
disease of the two. There is great variety in the degrees of this dis- 
ease there being all the gradations from the exact correspondence of 
the actions of all the parts to the testicles acting alone; in every case 
of the disease, there is too quick a secretion and evacuation of the 
semen. Like to the priapism, it docs not arise from desires and 



190 SUPPOSED CONSEQUENCES CHAP. XII. 

abilities, although when mild it is attended with both, but not in a 
due proportion; a very slight desire often producing the full effect. 
The secretion of the semen shall be so quick, that simple thought, or 
even toying, shall make it flow. 

Dreams have produced this evacuation repeatedly in the same night; 
and even when the dreams have been so slight, that there has been no 
consciousness of them when the sleep has been broken by the act of 
emission. I have known cases, where the testicles have been so 
ready to secrete, that the least friction on the glans has produced an 
emission: I have known the simple action of walking, or riding, 
produce this effect, and that repeatedly, in a very short space of 
time. 

A young man, about four or five and twenty years of age, not so 
much given to venery as most young men, had these last-mentioned 
complaints upon him. Three or four times in the night he would 
emit; and if he walked fast, or rode on horseback, the same thing 
would happen. He could scarcely have connection with a woman 
before he emitted, and in the emission there was hardly any spasm. 
He tried every supposed strengthening medicine, as also the cold 
bath, and sea-bathing, but with no effect. By taking twenty drops 
of laudanum, on going to bed, he prevented the night emissions; and 
by taking the same quantity in the morning, he could walk or ride, 
without the before-mentioned inconvenience. I directed this prac- 
tice to be continued for some time, although the disease did not re- 
turn, that the parts might be accustomed to this healthy state of 
action; and I have reason to believe the gentleman is now well. It 
was found necessary, as the constitution became more habituated to 
the opiate, to increase the dose of it. 

The spasms, upon the evacuation of the semen, in such cases, are 
extremely slight, and a repetition of them soon takes place; the first 
emission not preventing a second; the constitution being all the time 
but little affected.* When the testicles act alone, without the ac- 
cessory parts taking up the necessary and natural consequent action, 
it is still a more melancholy disease; for the secretion arises from 
no visible or sensible cause, and does not give any visible or sensible 
effect, but runs off similar to involuntary stools, or urine. It has 
been observed, that the semen is more fluid than natural in some of 
these cases. 

There is great variety in the diseased actions of these parts, of 
which the following case may be considered as an example. 

A gentleman has had a stricture in the urethra for many years, for 

* It is to be considered, that the constitution is commonly affected by the 
spasms only, and in proportion to their violence, independent of the secre- 
tion and evacuation of the semen. But in some cases even the erection going- 
off without the spasms on the emission, shall produce the same debility as if 
they had taken place. 



SECT. II. -OF GONORRHOEA. 191 

which he has frequently used a bougie, but of late has neglected it. 
He has had no connexion with women for a considerable time, being; 
afraid of the consequences. He has often in his sleep involuntary 
emissions, which generally awake him at the paroxysm; but what sur- 
prizes him most is, that often he has such, without any semen pass- 
ing forwards through the penis, which makes him think that at those 
times it goes backwards into the bladder. This is not always the 
case, for at other times the semen passes forwards. At the time the 
semen seems to pass into the bladder, he has the erection, the dream, 
and is awaked with the same mode of action, the same sensation, 
and the same pleasure, as when it passes through the urethra, 
whether dreaming or waking. My opinion is, that the same irrita- 
tion takes place in the bulb of the urethra, without the semen, that 
takes place there when the semen enters, in consequence of all the 
natural preparatory steps, whereby the very same actions are excited 
as if it came into the passage; from which one would suppose, that 
cither semen is not secreted, or if it be, that a retrograde motion takes 
place in the actions of the accelerators urinae; but if the first be the 
case, then we may suppose that in the natural state the actions of 
those muscles do not arise simply from the stimulus of the semen in 
the part; but from their action being a termination of a preceding 
one, making part of a series of actions. Thus they may depend upon 
the friction, or the imagination of a friction on the penis, the testicles 
not doing their part, and the spasm in such cases arising from the 
friction and not from the secretion. 

In many of those cases of irregularity, when the erection is not 
strong, it shall go off without the emission; and at other times an 
emission shall happen almost without an erection; but these arise not 
from debility, but affections of the mind. 

In many of the preceding cases, washing the penis, scrotum, and 
perinaeum with cold water, is often of service; and to render it colder 
than we find it in some seasons of the year, common salt may be add- 
ed to it, and the parts washed when the salt is almost dissolved. 

There is not a passage in any medical writer that marks more 
strongly than this chapter the proper connexion between physics and 
metaphysics; that is to say, that after establishing certain natural 
laws, or tracing a certain train of events, which, in the progress of 
nature, follow each other, instructs us so well how far we may ven- 
ture to suggest the causes which may interfere with that train, so as 
to prevent the ultimate effect. If Mr. Hunter has not, on this occa- 
sion, produced every inference which the subject admits, and per- 
haps requires, it is probably because those which he omitted were 
so obvious to himself, as seemingly not to require being pointed out 
to others. 

It has been thought by some, that too little notice is here taken of 



192 SUPPOSED CONSEQUENCES CHAP. XIl 

an indelicate custom. The reason of this is obvious from what fol- 
lows concerning impotence arising from the mind. If, as is no un- 
common event, an eager bridegroom should be disappointed in the 
fulfilment of expectations, which have long occupied his whole wishes, 
his embarrassment will produce a sort of temporary inability, which, 
in his despondency, he may impute to the recollection of events, the 
more distressing as they cannot now be recalled. Under these cir- 
cumstances he applies to his medical friend, if he has one, in whom 
he has sufficient confidence. The duty of the latter should be, as 
much as possible, to relieve his patient from an impression so fatal to 
his future success. In the way of conversation, he will soon learn, 
that the whole cause of failure must be ascribed to some impression 
of the mind. The most common cause is emissio ante coitum. Un- 
conscious that this event has arisen only from the force of desire, or 
perhaps unconscious that it has happened at all, he at once deems 
himself incompetent. 

I recollect an instance of the most profligate character I ever 
knew, who felt so respectful an attention to his bride, as absolutely un- 
fitted him, for a time, for the purposes of their congress; she had pre- 
viously conducted herself with a reserve he had been unaccustom- 
ed to among his former associates. This conduct had produced 
sentiments of distant respect, ill suited to the occasion, and which 
the lady would gladly have excused. This man had been too con- 
stantly in the habit of exerting his powers to doubt them, so that the 
impression soon subsided; but in one of a different character the con- 
sequence might have been more permanent, as the mind might with 
difficulty recover from its illusion. 

In this view it is, with much justice, that Mr. Hunter remarks the 
injury which books on this subject have done. Were they perused 
at the age when the practice is too common, perhaps they might be 
useful, by a bare apprehension of a calamity, of all others the 
most alarming. But in after life they can only produce despondency, 
which, of all other things, is the most likely to perpetuate such a sup- 
posed calamity. 

In his first edition, Mr. Hunter had made some further observations, 
the evident intention of which was to relieve the mind of certain in- 
dividuals from apprehensions which, whilst they exist, must be at- 
tended with the consequences above mentioned. The unfeeling 
ribaldry of some writers probably induced him to omit, in the present 
edition, a train of reasoning, to which there might be some objection. 
Not feeling myself at liberty to make any alteration in the text as it 
now is, I shall only remark, that one inference may be fairly drawn 
from Mr. Hunter's general mode of reasoning, in every subject con- 
nected with the animal economy. 

The organs of which we are now speaking, have, like all others, 
their proper stimuli to bring them into action; and, in proportion as 
they obey these stimuli, their actions may be called natural or healthy. 



SECT. "• OF GONORRHOEA. 192. 

But, if they are often stimulated unnaturally, such a mode of stimu- 
lating may become habitual, and even necessary to excite them into 
action; and if that action, even under the most favourable circum- 
stances, is found rarely to take place, whilst the mind is occupied with 
a gloomy impression, the consciousness of this imperfection will 
prove a means of its perpetuation. This view of the disease at once 
suggests the remedy, viz. a dereliction of the unnatural stimulus, by, 
which the parts will gradually feel the impression of their proper sti- 
muli — and as these stimuli produce their first impression on the 
mind, it is absolutely necessary that it should be free from every 
gloomy impression, particularly from such as might be excited by 
the very object which should prove the stimulus to the natural or 
healthy, action. 

It is probable that, having been frequently consulted on cases in 
which he found it necessary first to relieve the mind of his patient, 
Mr. Hunter was induced, from motives of the purest benevolence, to 
dwell so long on this subject. 



CHAP. XIII 



Of the Decay of the Testicle. 

It would appear, from some circumstances, that the parts of gene- 
ration are not to be considered as necessary parts of the animal ma- 
chine, but only as parts superadded for particular purposes; and there- 
fore only necessary when those particular purposes are to be answer- 
ed; for we may observe, that they are later of coming to maturity than 
any other parts, and are more liable to decay. Thus far in their 
natural properties they are different from most other parts of our 
body, the- teeth only excepted, which are similar in some of those 
circumstances. 

The testicles appear to be more subject to spontaneous disease than 
any other part of the body; but what is the most singular thing of all 
is, the wasting of those bodies. One or both testicles shall wholly 
disappear, like to the thymus gland, or membrana pupillaris, &c. in 
the infant. This we do not find in any parts of the body which are 
essential to its economy; excepting the parts are of no further use, 
and might become hurtful in the body, as in the instance of the mem- 
brana pupillaris; but the testicles do not undergo this change, as if in 
consequence of an original property stamped upon them, as is the case 
of the thymus gland, whenever the age of the person is such as to 
render them useless: but are liable to it at any age, and therefore the 

Bb 



194 SUPPOSED CONSEQUENCES CHAP. XIII. 

disposition is in the testicles themselves, independent of any con- 
nexion with the animal economy. An arm or leg may lose its action, 
and waste in part, but never wholly. 

Testicles have been known to waste in cases of rupture, probably 
from the constant pressure of the intestine. Mr. Pott has given us 
cases of this kind. I have seen in the hydrocele the testicle almost 
wasted to nothing, probably from the compression of the water; but 
in all these the causes of wasting are obvious, and would probably 
produce similar effects in other parts of the body under the same 
circumstances; but a testicle without any previous disease wastes 
wholly, or at other times it inflames, either spontaneously, or from 
sympathy with the urethra, becomes large, and then begins to sub- 
side, as in the resolution of common inflammation of the body, but 
does not stop at the former size, but continues to decay till it wholly 
disappears. The following cases are instances of this: — 

Case I. A gentleman, about nine years ago, had a gonorrhoea, 
with a bubo, which suppurated. A swelling of one of the testicles 
came on, for which he used the common methods of producing reso- 
lution, and seemingly with success. All the other symptoms being 
removed, he thought himself quite well; but some time after he 
found that the testicle, which had been swelled, was become rather 
smaller than the other, which made him now pay attention to it: this 
decrease continued, till it wasted entirely. For some years past, 
there has been no appearance of a testicle. He is not in the least 
different in inclination, or powers, from what he was before. 

Case. II. communicated by Mr. Nanfan. " A gentleman, aged 
about eighteen, who never had any venereal complaint, has had two 
different attacks of the same nature, one in each testicle. February 
3, 1776, after skating a few hours, without having, to his knowledge, 
received any injury from it, he was seized with a violent pain and 
inflammation of the left testicle, which, in a few days, increased 
much in size. A surgeon being sent for, followed the usual treat- 
ment in such cases of inflammation. In about six weeks the inflam- 
mation and swelling gradually subsided, some hardness only remain- 
ing. A mercurial plaster was now applied, which, after being worn 
for some time, was left off. The testicle ever since has continued 
gradually to decrease, and is no larger than a horse-bean; indeed 
the body of the testicle is quite decayed, nothing remaining but what 
seems part of the epididymis. It appears to have no sense of pain, 
except when pressed, and is very hard and uneven on its surface! 
The spermatic chord is not in the least affected. October 20, 1777, 
he was seized in the same manner in the right testicle, without any 
apparent cause; whereupon I was applied to. He was immediately 
bled; took an opening mixture;, after that a saline mixture, with 
tartar emetic, and a fomentation and embrocation of spiritus minde- 
reri, and spiritus vini, was used. On the 27th, a cataplasm was ap- 
plied of linseed meal, and aqua-vegito-mineralis. This treatment 



CHAP. XIII. OF GOxNORRH(EA. 195 

was persisted in till about the middle of November. The inflamma- 
tion went off, and the testicle seemed much in the natural state. On 
Dec. 19, I was applied to again; it seemed to be growing hard, and 
decreasing in size, much in the same manner as the other had done, 
which made him very unhappy. I ordered him some pills, with 
calomel and tartar emetic, in hopes of increasing the secretion of the 
glands in general, and making some change in the testicle. At first 
this method seemed to be of service, but soon lost its effects, and the 
testicle began to decrease just as the other did." Mr. Adair and 
Mr. Pott were consulted with me; but nothing could be thought of 
that could give any hopes of success. I advised him to employ the 
parts in their natural uses, as much as inclination led him; but all 
was to no purpose: the testicle continued to decrease, till not a ves- 
tige was left. 

Case III. communicated by Dr. Cotham, of Worcester. "A young 
man, aged sixteen, was suddenly seized with great coldness and 
shivering, attended with frequent rigors. During this paroxysm, 
which continued three hours, his pulse was small and contracted, 
and so exceedingly quick, that the strokes of the artery were with 
difficulty counted. This period was succeeded by an intense heat, 
and a strong, hard, full pulse, on which account he was copiously 
bled; a dose of cooling physic was immediately administered, and a 
clyster thrown up to promote its more speedy effects. In the even- 
ing the bleeding was repeated. All this day he complained of ex- 
cruciating pain in his loins, and the side of his belly descending down 
into the scrotum. On examining the part affected, I saw an appear- 
ance of inflammation in the groin of the left side, and a great tension 
about the ring of the abdominal muscles, with an enlargement of the 
testicles. These parts were now ordered to be fomented with a dis- 
cutient fotus strongly impregnated with crude sal ammoniac, and to 
be bathed with spiritus mindereri, and spiritus volat. aromat. before 
the application of each stupe; and he was directed to take six grains 
of the pulv. antimonialis, with fifteen grains of nitre, every three 
hours; his food to be thin gruel, with fruit and lemon-juice, and his 
drink barley-water, with sugar and nitre. Notwithstanding this an- 
tiphlogistic plan of frequent cooling physic, anodynes, three emetics, 
and thirteen blood-lettings, the fever continued, and the pain, inflam- 
mation, and tumor, increased till the eighth day, including the first 
day of seizure; when, seeing no hope of discussing the tumor, the tes- 
ticle being nearly as large as a child's head, I attempted by emolli- 
ent fotuses, and maturating cataplasms, to bring it to suppuration. 
On the 10th, a fluctuation was perceptible; and on the 12th, much 
more so, the scrotum then having put on a livid appearance. I used 
every possible argument for permission to open it, but he being now 
quite easy would not admit it. On the 15th, the patient was again 
attacked with rigors, coldness, and shivering, succeeded by a great 
feverish heat which soon terminated in a profuse sweat, yet no pain 



196 SUPPOSED CONSEQUENCES CHAP. XMI. 

attended this paroxysm. In the evening, however, the tumor w;is so 
prominent, that I was of opinion it would open spontaneously before 
morning, when 1 hoped to obtain his consent to enlarge the aperture; 
but this not happening, and all intreaties, relating to the necessity of 
an incision, proving ineffectual, I contented myself with giving the 
bark with elixir of vitriol. From this time, after every paroxysm of 
fever, the testicle was observed to decrease. Not being permitted to 
make an incision, and his strength and appetite continuing good, I be- 
gan to entertain hopes of success without it, and advised him to per- 
sist in the use of the tonic and antiseptic plan, with the addition gf 
stupes, wet with the decoction of bark, to be constantly applied; by 
which means, at the end of thirty days from the first seizure, the pus 
was totally absorbed. The testicle then appeared to be of the size 
of a hen's egg, and was as hard as a scirrhus. I directed it to be 
rubbed, night and morning, with equal parts of the unguent, mercur. 
fort, and liniment, volat. camphorat. and ordered, internally, some 
mercurial alteratives, with a decoction of bark. By these aids his 
night-sweats, and every other disagreeable symptom, gradually 
abated; he gathered strength, flesh, and spirits, very fast, and the 
diseased testicle went on constantly decreasing, though very slowly, 
for near twelve months; at the expiration of which time there was 
no other appearance of it than a confusion of loose fibres, obvious 
to the feeling, in the upper part of the scrotum. About a month 
ago the patient consented to my examining it. Of the testicle there 
was not the least vestige, neither could I perceive the tunica vagi- 
nalis on that side in the groin; but upon the os pubis, and a little 
under it, I could embrace with my fingers and thumb the chord, and 
distinguish the vessels, which were without the least degree of hard- 
ness or scirrhosity; and if I pressed one in particular, I gave him ex- 
quisite pain for a moment. He is in perfect health, of a strong ro- 
bust constitution, and has fine healthy children; the only change 
which he has perceived in the constitution has been a propensity to 
grow fat, which neither temperance, nor violent exercise on horse- 
back, daily, with little rest, will prevent. 



When we see the progress that follows violent inflammation in 
the eye, we may the less wonder at the wasting of the testicle. The 
consequence of inflammation is, an increased volume of a part, either 
by an increase in the number or capacity of its vessels. When the 
inflammation has subsided, the next process must be to reduce the 
part to its former volume. This must be done by absorption of those 
parts which were added during the inflammation. When this pro- 
cess has commenced, it may be continued after the cause for which 
it was sat up has ceased. Thus, after violent and very sudden in- 
flammation in one eye, it is not uncommon to see the globe, after re- 



CHAP. XIII. OF GONORRHOEA. 197 

covery, somewhat less than in the other eye. I have even seen it 
recover its size afterwards; but this is very rare. 

A more common effect of very high inflammation under small- 
pox, from which disease I have made these remarks, is suppuration ; 
and if this take place with the eye-lids closed, it is not easy to per- 
ceive any escape of the matter, nearly the whole of which is proba- 
bly absorbed. Should suppuration take place in a testicle, without 
having previously produced adhesion between the tunica vaginalis 
and scrotum, there will be nothing to produce that sympathy in the 
latter, by which the parts anterior to collections of matter prepare 
themselves for the escape of it. Hence the probability is, that the 
matter, being contained within the tunica vaginalis, will be graduallv 
absorbed, like any other extraneous body. 

The most surprising instance of wasted testicles is in the unfortu- 
nate subjects of the true Elephantiasis. Here, without pain, or pre- 
vious local disease, the testicles gradually resolve themselves into a 
small packet of loose threads, which may be easily felt between the 
finger and thumb. These unhappy people, who, from the days of 
Aretaeus, have been accused of excessive venereal indulgence, are 
actually rendered incapable of the act; and if seized before the age 
of puberty, the testicles never increase at the customary period, nor 
do the youths acquire any of the other marks of virility. 



198 OF CHANCKfc v«AP. *• 



PART IV 



CHAP. I. 

Of Chancre. 

I have been hitherto speaking of the effects of this poison, when 
applied to a secreting surface and without a cuticle; of the intention 
of Nature in producing these effects; and of all the consequences, 
both real and supposed. I now mean to explain its effects when 
applied to a surface that is covered with a common cuticle, as the 
common skin of the body, which on such a surface will be found to 
be very different from those I have been describing. But I may be 
allowed here to remark, that the penis, the common seat of a chan- 
cre, is, like every part of the body, liable to diseases of the ulcerative 
kind; and from some circumstances rather more so than other parts; 
for if attention is not paid to cleanliness, we have often excoriations, 
or superficial ulcers, from that cause; also, like almost every other 
part that has been injured, these parts, when once they have suffer- 
ed from the venereal disease, are very liable to ulcerate anew. Since 
then this part is not exempted from the common diseases of the body, 
and as every disease in this part is suspected to be venereal, great 
attention is to be paid in forming our judgment of ulcers here. 

It is an invariable effect, that when any part of an animal is irri- 
tated to a certain degree, it inflames and forms matter, the intention 
of which is to remove the irritating cause. This process is easily 
effected when it is on a surface whose nature is to secrete; but when 
on a surface whose nature is not to secrete, it then becomes more 
difficult, for another process must be set up, which is ulceration. 
This is not only the case in common irritations, but also in specific 
irritations from morbid poisons, as the venereal disease and small- 
pox. The variolous matter, as well as the venereal, produces ul- 
cers on the skin; but when it affects secreting surfaces, a diseased 
secretion is the consequence; and this is different in different parts; 
on the tongue, inside of the mouth, uvula and tonsils, the coagulable 
lymph is thrown out in form of sloughs, somewhat similar to the pu- 
trid sore throat; but in the fauces and all down the oesophagus, a 
thickish fluid, in appearance like matter, is secreted. When the 
irritation is applied to a surface whose cuticle is thin, and where 



CHAP. I. OF CHANCRE. 199 

there is a secretion naturally, as the glans penis, or inside of the 
prepuce, there it sometimes only irritates, so as to produce a diseased 
secretion, as was described; but this is not always the effect of such 
irritation on such surfaces. They are often irritated to ulceration, 
and produce a chancre. 

The poison has in general either no disposition, or not sufficient 
powers, to blister or excoriate the common skin; for if it did, the 
symptoms most probably would be at first nearly the same, if not ex- 
actly so, with a gonorrhoea; that is, a discharge of matter from a 
surface, without a cuticle, newly inflamed; for it is reasonable to 
suppose, that the poison would produce on that excoriated surface a 
secretion of matter, which would be at first a gonorrhoea, and which 
very probably would afterwards fall into the second mode of action, 
or ulceration, and then become a chancre. 

There are three ways in which chancres are produced; first, by 
the poison being inserted into a wound; secondly, by being applied to 
a non-secreting surface; and, thirdly, by being applied to a common 
sore. To whichever of these three different surfaces it is applied, 
the pus produces its specific inflammation and ulceration, attended 
with a secretion of pus. The matter, produced in consequence of 
those different modes of application, is of the same nature with the 
matter applied, because the irritations are the same in both. 

The poison much more readily contaminates if it is applied to a 
fresh wound, than to an ulcer; in this resembling the inoculation of 
the small -pox. Whether there are any parts of the skin, or any 
other part of the body, more susceptible of this irritation than 
others, in consequence of local application, is not yet ascertained. 

This form of the disease, like the first, or gonorrhoea, is generally 
caught on the parts of generation, in consequence of a connection 
between the sexes; but any part of the body may be affected by the 
application of venereal matter, especially if the cuticle is thin. 

I have seen a chancre on the prolabium, as broad as a sixpence, 
caught, the person did not know how* The penis, and particularly 
the prepuce, being the parts most commonly affected by this form of 
the disease, are so constructed as to suffer much from it, especially 
when they are very susceptible of such irritation; for the construc- 
tion alone produces many inconveniences, besides considerable pain, 
while under the disease, and in general retards the cure. 

The chancre is not so frequent an effect of the poison as the go- 
norrhcea; and I think very good reasons may be assigned for it, al- 
though there are more modes than one of catching it, as I just now 
mentioned; but the parts in two of them, to wit, the wound, and the 

* Thai this sore was a chancre I make no doubt-; for, besides its diseased ap- 
pearance, he had a bubo forming in one of the glands under the lower jaw, on 

% Is mVstVrobable that his own fingers were the conveyers 



200 OF CHANCRE. CHAP. f. 

sore, are seldom in the way of being infected; therefore, when it is 
caught, it is commonly by the same mode of application with that of 
the gonorrhoea; but as the cuticle cannot be affected by this poison, 
this covering acting as a guard to the cutis, it is often prevented 
from coming in contact with it; and indeed it is almost surprising 
that the cutis should be affected by it, where it has such a covering, 
excepting about the glans, the inside of the prepuce, or other parts of 
the body, where this covering is thin. The proportion which the 
cases of gonorrhoea bear to those of chancre is as four or five to 
one. 

When it is caught in men, it is generally upon the fraenum, glans 
penis, prepuce, or upon the common skin of the body of the penis; 
and sometimes on the fore part of the scrotum; but I think most fre- 
quently on the fraenum, and in the angle between the penis and glans. 
Its affecting these parts arises from the manner in which it is caught, 
and not from any specific tendency in these parts to catch it more 
than others; and its affecting the fraenum, &c. more frequently than 
the other parts of the penis arises from the external form of this 
part, which is irregular, and allows the venereal matter to lie undis- 
turbed in the chinks; by which means it has time to irritate and in- 
flame the parts, and to produce the suppurative and ulcerative in- 
flammation in them. But as this matter is easily rubbed off from 
prominent parts, by every thing that touches them, it is a reason why 
such parts in general so often escape this disease. 

The distance of time between its application and its effects upon 
the part is uncertain; but, upon the whole, it is rather longer in ap-> 
pearing than the gonorrhoea; however, this depends in some measure 
on the nature of the parts affected. If it be the fraenum, or the ter- 
mination of the prepuce into the glans, that is affected, the disease 
will in general appear earlier; these parts being more easily affected 
than either the glans, common skin of the penis, or scrotum; for in 
some cases where both the glans and prepuce were contaminated 
from the same application of the poison, it has appeared earlier on 
the prepuce. 

I have known cases where the chancres have appeared twenty- 
four hours after the application of the matter; and others where it 
has been seven weeks. A remarkable case of this kind was in a 
gentleman who had not touched a woman for seven weeks, when a 
chancre appeared. That this was a venereal chancre was proved, 
by his having had the lues venerea from it, and being under a ne- 
cessity of taking mercury. An officer in the army had a chancre 
which appeared two months after he had had any connection with 
a woman. After the last connection he marched above an hundred 
miles, when the chancre broke out, and only gave way to mercury. 

This, like most other inflammations which terminate in ulcers, be- 
gins first with an itching in the part; if it is the glands that is in- 
flamed, generally a small pimple appears full of matter, without 



*HAP, I OF CHANCRE. 201 

much hardness, or seeming inflammation, and with very little tume- 
faction, the glans not being so readily tumefied from inflammation as 
many parts are, especially the prepuce; nor are the chancres attended 
with so much pain or inconvenience as those on the prepuce; but if 
upon the fraenum, and more especially the prepuce, an inflammation 
more considerable than the former soon follows, or at least the ef- 
fects of the inflammation are more extensive and visible. Those 
parts, being composed of very loose cellular membranes, afford a 
ready passage for the extravasated juices: continued sympathy also 
more readily takes place in them. The itching is gradually changed 
to pain; the surface of the prepuce is, in some cases, excoriated, 
and afterwards ulcerates. In others, a small pimple, or abscess, ap- 
pears, as on the glans, which forms an ulcer. A thickening of the 
part comes on, which at first, and while of the true venereal kind, is 
very circumscribed, not diffusing itself gradually and imperceptibly 
into the surrounding parts, but terminating rather abruptly. Its base 
is hard, and the edges a little prominent. When it begins on the 
fraenum, or near it, that part is very commonly wholly destroyed, or 
a hole is often ulcerated through it, which proves very inconvenient 
in the cure; and in general it had better, in such cases, be divided 
at first. 

Venereal ulcers commonly have one character, which, however, is 
not entirely peculiar to them, for many sores that have no disposition 
to heal, (which is the case with a chancre,) have so far the same cha- 
racter. A chancre has commonly a thickened base; and although 
in some the common inflammation spreads much further, yet the spe- 
cific is confined to this base. The future, or consequent ulcers, are 
commonly easily distinguished from the original, or venereal, which 
will be described hereafter. 

If the venereal poison should be applied to the skin, where the 
cuticle is more dense than that of the glans penis, or fraenum, such 
as that upon the body of the penis, or forepart of the scrotum, (parts 
which are very much exposed to the application of this matter,) then 
it generally first appears in a pimple, which is commonly allowed to 
scab, owing to its being exposed to evaporation. This scab is gene- 
rally rubbed off, or pushed off, and one larger than the first forms. I 
think there is less inflammation attending these last than those on 
the fraenum and prepuce; but more than those upon the glans. 

When the disease is allowed to go on, so as to partake of the in- 
flammation peculiar to the habit, it becomes, in many instances, 
more diffused, and is often carried so far, as to produce disagreeable 
symptoms, as phvmosis, and sometimes paraphimosis, greatly retard- 
ing the cure; but still there is a hardness peculiar to this poison sur- 
rounding the sores, especially those upon the prepuce. 

When these ulcers are forming, and after they are formed, or in 
the state of inflammation, it is no uncommon thing for the urethra to 
sympathize with them, and give a tickling pain, especially in making 

< c 



202 OF CHANCRE. CHAP. I. 

water; but whether or not there is ever a discharge in the urethra 
from such a cause, I will not determine; but if a discharge never 
takes place but when the disease really attacks the urethra, it would 
make us suppose that this sympathy is not really inflammatory; or if 
it is carried so far as to produce inflammation, yet that is not of the 
specific kind. However, it is possible in those cases where there is 
a gonorrhoea preceded by a chancre, that this gonorrhoea may arise 
from sympathy, and is not a disease proceeding from the original 
contamination, nor from the matter of the chancre. That the sen- 
sation in the urethra, in those instances where there is no discharge, 
is from sympathy, and not from the urethra being attacked with 
the disease at the time that the matter laid the ground-work for the 
chancre, is evident from the following observation. I have seen it 
happen more than once, when the seat of the chancre had broke out 
a second time, and where no new or fresh infection had been caught, 
that the patient complained of the same tickling or slight pain in the 
urethra before any discharge had taken place in the beginning ulcer- 
ations. From the same connection of parts I have seen a chancre 
coming upon the glans absolutely cure both a gleet and an irritation 
ail along the passage of the urethra. So great was the previous ir- 
ritation in this case, that I suspected a stricture; but, on passing a 
bougie, found none. 

In consequence of the urethra sympathising with the chancre, the 
testicles and scrotum will further sympathise with the urethra, and 
become affected. I have seen this sympathy extend over the Avhole 
pubes, and so strong, that touching the hairs gently on the pubes has 
given disagreeable sensations, and even pain. 

In speaking of the local, or immediate effects of the vene- 
real disease, I mentioned that they were seldom wholly specific, 
and that they partook both of the specific and the constitutional 
inflammation; and therefore it is always very necessary to pay 
some attention to the manner in which chancres first appear, and 
also to their progress; for they often explain the nature of the consti- 
tution at the time. If the inflammation spreads fast, and considera- 
bly, it shows a constitution more disposed to inflammation than natu- 
ral. If the pain is great, it shows a strong disposition to irritation. 
It also sometimes happens that they begin very early to form 
sloughs; when this is the case they have a strong tendency to 
mortification. 

These additional symptoms mark the constitution, and direct the 
future mode of treatment. 

When there is a considerable loss of substance, either from slough- 
ing or ulceration, a profuse bleeding is no uncommon circumstance, 
more especially if the ulcer is on the glans; for it would appear that 
the adhesive inflammation does not sufficiently take place there to 
unite the veins of the glans so as to prevent their cavity from being 
exposed, and the blood is allowed to escape from what is called the 



CHAP. I. OF CHANCRE. 203 

corpus spongiosum urethra?. The ulcers, or sloughs, often go as deep 
as the corpus cavernosum penis, where the same thing happens. 



In this most important section there is a heaviness of style which 
so fatigues the attention as to produce a seeming obscurity on the 
whole. After many attempts at illustrating the several paragraphs 
as they occur, I have thought it most convenient, by retracing the 
whole, to give Mr. Hunter's meaning in a language more suited to 
those who were not frequently in the habit of conversing with him. 

The section comprehends, 

1st. A short recapitulation of the difference in the effect produced 
by irritating substances applied to parts, whether secreting surfaces, 
particularly mucous membranes, parts covered with a very thin cuti- 
cle, or parts covered with the common cuticle. The effect on mu- 
cous membranes having been already considered, all that is necessaij 
to be remarked here is, that the glans penis, corona, and inside of the 
prepuce, are to be considered as secreting surfaces, with very thin 
cuticle, consequently that pus may be secreted on them without a 
breach of their solid parts, but that ulceration more easily takes place 
in them than in parts which are covered by the common cuticle. 
The common cuticle, it is observed, cannot be excited to vesication 
by the venereal matter, and some conjectures are offered of the pro- 
bable consequence of the application of that matter to an excoriated 
surface. This, it is presumed, might be at first a mere secretion 
from the part, as we find follows the application of common vesica- 
tories, but that ulceration would probably follow, as is the case when 
vesicated parts are prevented from healing by a continuance of irri- 
tating applications. 

2dly. Three ways are described in which venereal matter may be 
applied so as to produce its effects. These observations are well 
worth attending to, and are sufficiently explained by Mr. Hunter. 
The reason why a fresh wound is more liable to receive the impres- 
sion than an ulcer, he used to remark, was probably from the ulcer 
being covered by its own pus, which may prevent the venereal matter 
from coming in contact with the living part. Many reasons are of- 
fered why gonorrhoea is a more common form of the disease than 
chancre. I cannot help adding that this maybe at once accounted 
for by gonorrhoea arising from so many causes, and the impossibility 
of distinguishing the venereal from any other. 

Sdly The parts of the penis on which the disease is more com- 
monly caught, are next distinguished with the accuracy peculiar to 
our author: and this leads to the description of the true chancre and 
also to the cause of its peculiar distinction from every other ulcer. 
On the first application of venereal matter, the same symptoms occur 
as from any other stimulating application to such a part, viz. the for- 



204 OF CHATICRE. CHAP. 1. 

mation of an ulcer, either by excoriation, or by matter formed under 
the thin cuticle, like a small abscess. The true ulcer follows, which 
at first is not distinguishable by any particular sign. " A thickening 
soon comes on, not diffusing itself into the surrounding part, but ter- 
minating abruptly. Its base is hard, and edges a little prominent." 

At the end of this paragraph, I have transposed one which in the 
text stands the second in order in this section. This is the only liber- 
ty I have ventured to take with the work, which I trust the reader 
will pardon, as it here proves particularly useful in tracing the chain 
of events, and the most probable causes. 

" Venereal ulcers commonly have one character, which, however, 
is not entirely peculiar to them, for many sores that have no disposi- 
tion to heal, (which is the case with a chancre,) have so far the same 
character. A chancre has commonly a thickened base; and although 
in some the common inflammation spreads much further, yet the 
specific is confined to this base." This hard edge and base have 
been noticed by other writers; but Mr. Hunter only has traced the 
cause. This character, he remarks, is not entirely peculiar to vene- 
real sores, but arises from their having no disposition to heal of them- 
selves. It is well known that sores, when frequently prevented from 
healing, will form a thickened, or, as it is called, a callous edge, 
around them, after which they remain stationary. If the healing 
process is commenced, the first step is the absorption of this callous 
edge by the ulcerative process,* usually called digestion. 

Now when venereal virus first produces its irritation on a non- 
secreting surface, the consequence, as in other irritations, is ulcera- 
tion. But this ulceration will not prove a cure as it does in other 
cases of irritation, because, when the venereal action is once set up, 
the constitution has no power of changing it.f Hence the attempt at 
healing being given up, the hard base is formed as in " those sores 
which have no disposition to heal." But the venereal ulcer, though 
it has no disposition to heal, cannot be stationary, like a common 
sore, because the irritation for the same action still continues: hence 
this callous edge will be absorbed in the same manner as the edge of 
a chronic ulcer is absorbed, as soon as the parts are stimulated by 
what are called digestive remedies. The consequence of two such 
causes in the chancre must be, a perpetual formation of this thick- 
ened edge and base, and also a perpetual ulceration of it; so that 
as long as the sore retains its true character, ulceration will make 
only a slow progress, being perpetually retarded by this thickened 
edge and base. 

Lastly, such circumstances are enumerated as interfere with these 

* Celsus has very accurately marked these processes, lib. 5 can 37 
sect. 51. i • • 

. + See page 46, « Of the common final attempt of suppuration not answcrinff 
in this disease." to 



SECT. l - OF CHANCRE. 205 

laws, or this train of actions. This regularity, it is shown, can only 
exist as long as the chancre retains its true character; during which 
time it preserves its specific distance. " The thickening of the part," 
says Mr. Hunter, "while of the true venereal kind, is very circum- 
scribed; not diffusing itself gradually and imperceptibly into the sur- 
rounding parts, but terminating rather abruptly." In this sentence 
the reader will perceive the specific distance, which, as we before 
observed, marks the legitimate progress of morbid poisons. In the 
succeeding paragraphs are shewn the most common consequences of 
any interruption to the true progress of the disease, by constitutional 
peculiarity, accidental intemperance, or other causes; one of the 
first effects of which is, that the specific distance can no longer 
be traced. 

I do not conceive that this part can be expressed with more accu- 
racy or perspicuity than it is in the text. 

The whole of this chapter is highly important, and should be perused 
with the strictest attention; and if it is not rendered more conspicu- 
ous by this commentary, the writer must regret his own incapacity, 
but cannot accuse his want of industry. 



SECTION I. 

Of the Phymosis and Paraphimosis. 

These diseases arise from a thickening of the cellular membrane 
of the prepuce, in consequence of an irritation capable of producing 
considerable and diffused inflammation, which, when it does happen, 
is generally in consequence of a chancre in this part. This irrita- 
tion, however, and inflammation, sometimes attack the prepuce,* 
even when the disease is in the form of what I suspect to be a gonor- 
rhoea of the glans and prepuce, sometimes even in the common 
gonorrhoea, but most frequently of all from a chancre in the prepuce. 
When this disease or tumefaction takes place in consequence of a 
chancre, I suspect that there is an irrritable disposition in the habit; 
for it is plain there is more than the specific action, the inflammation 
extending beyond the specific distance. 

It may be observed here, that the prepuce is no more than a dou- 
bling of the skin of the penis when not erected, for then it becomes 
too large for the penis, by which provision the glans is covered and 
preserved when not necessary to be used, whereby its feelings arc 

* See page 53, where this gonorrhoea is mentioned. 



JOG OF CHANCRE. ^ilAP. f. 

probably more acute. When the penis becomes erect, it in general 
tills the whole skin, by which the doubling forming the prepuce 
in the non-erect state is unfolded, and is employed in covering the 
body of the penis. 

The diseases called phymosis and paraphimosis, being a thicken- 
ing of the cellular membrane of this part, they will commonly be in 
proportion to the inflammation and distensibility of the cellular mem- 
brane of the part. The inflammation often runs high, and is fre- 
quently of the erysipelatous kind; besides, in such parts where the 
cellular membrane is so very loose, the tumefaction is considerable, 
and the end of the prepuce being a depending part, the serum is ac- 
cumulated in it, which in many inflammations is allowed to pass 
from the inflamed to some more depending part, as in an inflammation 
of the leg or thigh, where the foot commonly swells or becomes oede- 
matous, in consequence of the descent of the serum extravasated 
above. 

A natural contraction of the aperture of the prepuce is very com- 
mon, and so strong in some, that those under such construction of 
parts have a natural and constant phymosis. Such a state of parts is 
often attended with chancres, producing very great inconveniences in 
the time of the cure; and in those cases of considerably diffused in- 
flammation, a diseased phymosis, similar to the other, unavoidably 
follows; and, whether diseased or natural, it may produce the para- 
phymosis simply by the prepuce being brought back upon the penis; 
for this tight part acting as a ligature round the body of the penis, be- 
hind the glans, retards the circulation beyond the ligature, producing 
an (Edematous inflammation on the inverted part of the prepuce. 
When the paraphymosis takes place in consequence of a natural 
tightness only, although attended with chancres, yet it has nothing 
to do with the constitution, this being only accidental; however, in 
either case, a paraphymosis is to be considered as in some degree a 
local violence. 

This natural phymosis is so considerable in some children as not 
to allow the urine to pass with ease, but in general becomes larger 
and larger, as boys grow up, by frequent endeavours to bring it over 
the glans, by which the bad consequences, that would otherwise 
ensue in it when affected with disease, are often prevented. 

This part of the prepuce, although in most men it is loose enough 
to produce no inconvenience in a natural state, yet it sometimes con- 
tracts without any visible cause whatever, and becomes so narrow as 
to hinder the water from getting out, even after it has got free of the 
urethra, so that the whole cavity of the prepuce shall be filled with 
the urine, and give great pain. The cases that I have seen of this 
kind have been principally in old men. 

When the prepuce is in its natural position it then covers entirely 
the glans, and is commonly a little loose before it; but when it begins 
to swell and thicken, more and more of the skin of the penis is drawn 



SECT. I. OP CHANCRE. 2CH 

forwards over the glans, and the glans at the same time is pushed 
backwards by the swelling against its end. I have seen the prepuce 
projecting from such a. cause more than three inches beyond the glans, 
and its aperture much diminished. 

The prepuce often becomes in some degree inverted by the 
inner skin yielding more than the outer, having a kind of neck where 
the outer skin naturally terminates. From the tightness and disten- 
tion of the parts in a state of tumefaction it becomes impossible to 
bring it back over the penis, so as to invert it, and expose the sores 
on Ihe inside. 

Such a state of the prepuce is very often productive of bad conse- 
quences, especially when the chancres are behind the glans, for the 
glans being between the orifice of the prepuce and the sores, it there 
fills up the whole cavity of the prepuce, between the chancres and 
opening, and often so tightly that the matter from the sores behind 
cannot get a passage forwards between the glans and prepuce, by 
which means there is an accumulation of matter behind the 
corona glandis, forming an abscess which produces ulceration 
upon the inside of the prepuce; this abscess opens externally, and 
the glans often protruding through the opening, throws the whole 
prepuce to the opposite side, the penis appearing to have two termi- 
nations. 

On the other hand, if the prepuce is loose, wide, and is either ac- 
customed to be kept back in its sound state, or is pulled back to 
dress the chancres, and is allowed to remain in this situation till the 
above tumefaction takes place, then it is called a paraphymosis; or, 
if the prepuce is pulled forcibly back after it is swelled, it is then 
brought from the state of a phymosis, as before described, to that of a 
paraphymosis. 

This last described situation of the prepuce is often much more 
troublesome, and often attended with worse symptoms than the 
former, especially if it should have been changed from a phymosis 
to a paraphymosis. The reason of which is, that the aperture of the 
prepuce is naturally less elastic than either the internal inverted part, 
or the external skin; therefore, when the prepuce is pulled back 
upon the body of the penis, that part grasps it tighter than any other 
part of the skin of the penis, and more so in proportion to the in- 
flammation; the consequence of which is, the swelling of the pre- 
puce is divided into two, one swelling close to the glans, the other 
behind the stricture or neck. This stricture is often so great as to 
interrupt the free circulation of the blood beyond it, which also as- 
sists in increasing the swelling, adds to the stricture, and often pro- 
duces a mortification of the prepuce itself, by which means the whole 
diseased part, together with the stricture, is sometimes removed, 
forming what may be called a natural cure.* 

* A young- man came into St. George's Hospital, with a paraphymosis, in 



20$ OF CHANCRE. CHAP. II. 

In many cases the inflammation not only affects the skin of the 
penis, in which is included the prepuce, but it attacks the body of 
the penis itself, often producing adhesions, and even mortification, 
in the cells of the corpora cavernosa, either of which will destroy 
the distensibility of those parts ever after, giving the penis a curve to 
one side in its erections. This sometimes takes place through the 
whole cellular substance of the penis, producing a short and almost 
inflexible stump. 

The adhesions of those cells do not proceed from venereal inflam- 
mations only; they are often the consequences of other diseases, and 
sometimes they take place without any visible cause whatever. 

A gentleman, sixty years of age, who has been lame with the gout 
these twenty years past, has for these eighteen months had the penis 
contracted on the left and upper side, so as to bend that way very 
considerably in erections, which erections are more frequent than 
common. 

Quere: Is the gout the cause of this, by producing adhesions of 
the cells of one corpus cavernosum, so as not to yield to, or allow of, 
the influx of blood on that side? And is the irritation of the gout the 
cause of the frequency of the erections? 



CHAP. II. 



Of Chancres in Women. 

Women are subject to chancres; but, from the simplicity of the 
parts, the complaint is often less complicated than in men: for, in this 
sex, we have only the disease and constitutional affection, and no in- 
convenience arising from the formation of the parts. 

When the matter is introduced into the vagina, or urethra, it there 
irritates a secreting surface, as I described when treating of the disease 
in general, and of women in particular; but when it is lodged in the 
inside of the skin of the labia, or lymphae, those parts are often only 
affected with gonorrhoea; but, like the glans penis in men, they are 
also capable of ulceration. Ulcerations are generally more numerous 
in women, because the surface upon which they can form is much 

consequence of chancres on the inside of the prepuce. All the parts before 
the stricture, formed by the prepuce, mortified and dropped off". I ordered 
nothing but common dressings, and it healed very readily ; and he left the hos- 
pital cured of the local complaint. Whether or not absorption had taken place, 
previous to the mortification, I do not know, as I never heard more of him. 



CHAP. III. OF CHANCRE. 209 

larger. We find them on the edge of the labia, sometimes on the 
outside, and even on the pcrinaeum. 

Ulcers that are formed on the inside of the labia, or nymphae, are 
never allowed to dry or scab; but on the outside they are subject to 
have the matter dry upon them, which forms a scab similar to those 
on the body of the penis, or scrotum. 

The venereal matter from such sores is very apt to run down the 
perinaeum to the anus, as in a gonorrhoea, and excoriate the parts, 
especially about the anus, where the skin is thin, and often produce- 
chancres in those parts. 

Chancres have been observed in the vagina, which I suspect not 
to have been original ones; but to have arisen from the spreading of 
the ulcers on the inside of the labia. 

This form of the disease, like the gonorrhoea, both in women and 
in men, is entirely local, the constitution having no connexion with 
it but sympathetically; and I believe much more, seldom in this than 
in the former. 



CHAP. III. 



General Observations on the Treatment of Chancres. 

The inflammation from the venereal poison, when it produces ul- 
ceration, generally, if not always, continues till cured by art; which 
I observed was not the case with gonorrhoea. It will, perhaps, not 
be an easy task to account for this material difference in the two 
kinds of disease; but I am inclined to think, that, as the inflamma- 
tion in the chancre spreads, it is always attacking new ground, which 
is a succession of irritations, and is the cause that it does not cure 

itself. 

Chancres, as well as the gonorrhoea, are, perhaps, seldom or ever 
wholly venereal; but are varied by certain peculiarities of the con- 
stitution at the time. The treatment, therefore, of them, both local 
and constitutional, will admit of great variety; and it is upon the 
knowledge of this variety that the skill of the surgeon principally 
depends. On this account, the concomitant symptoms are what re- 
quire particular attention. Mercury is the cure of the venereal 
symptoms abstractedly considered; but there is no one specific for 
tiie others the treatment of which must vary, according to the con- 
stitution ' From hence we must see, that no one kind of medicine 
joined with mercury, will be likely to succeed in all cases, although 
the different pretended secrets are of this kind: some cases not re- 

d d 



210 OF CHANCRE. CHAP. III. 

quiring any thing excepting mercury; others requiring a something 
besides, according to their nature, which, in many cases, it will not 
be an easy matter to find out, from the appearances of the chancre it- 
self; but which must be discovered by repeated trials. 

Probably from the before-mentioned circumstances it is, that a 
chancre is, in common, longer in healing than most of the local ef- 
fects from the constitutional disease, or lues venerea; at least longer 
than those in the first order of parts; and this is found to be the case, 
notwithstanding that the cure of a chancre may be attempted, both 
constitutionally and locally, while the lues venerea can, in common, 
only be cured constitutionally. It is commonly some time before a 
chancre appears to be affected by the medicine. The circulation 
shall be loaded with mercury for three, four, or more weeks, before 
a chancre shall begin to separate its discharge from its surface, so as 
to look red, and show the living surface; but when once it does 
change, its progress towards healing is more rapid. A lues venerea 
shall, in many cases, be perfectly cured, before chancres have made 
the least change. 

Upon the same principle some attention should be paid to internal 
medicines; and it should be considered whether weakening, strength- 
ening, or quieting medicines should be given; for sometimes one 
kind, sometimes another, will be proper. 

Chancres admit of two modes of treatment; the object of the one 
is, to destroy or remove them by means of escharotics, or by extirpa- 
tion; that of the other is, to overcome the venereal irritation by 
means of the specific remedy for that poison. 

I have endeavoured to show, that chancres are local complaints: 
this opinion is further confirmed, by their being destroyed, or cured, 
by merely a local treatment. But in chancres, as well as in a go- 
norrhoea, it has been disputed, whether mercury should ever be ap- 
plied locally to them, or not: some have objected to it, while others 
have practised it; and probably the dispute is not yet generally 
settled. 

Upon the general idea which I have endeavoured to give of the 
venereal disease, it can be no difficult task to determine this ques- 
tion. 

It is to be observed, that in the cure of the chancres we have two 
points in view — the cure of the chancre itself, and the prevention of 
a contamination of the habit. 

The first, or the cure of the chancre, is to be effected by mercury, 
applied either in external dressings, or internally, through the circu- 
lation; or in both ways. The second object, or preservation of the 
constitution from contamination, is to be obtained, first by shortening 
ike duration of the chancre, which shortens the time of absorption, 
and also by internal medicine, which must be in proportion to the 
time that the absorption may have been going on. 

If the power of a chancre to contaminate the constitution, or. 



CHAP. III. OF CHANCRE. ;Ii 

which is the same thing, if the quantity absorbed is as the size of the 
chancre, and the time of absorption, which most probably it is, then 
whatever shortens the time must diminish that power, or quantity 
absorbed; and if the quantity of mercury necessary to preserve the 
constitution is as the poison absorbed, then whatever lessens the 
quantity absorbed must proportionally preserve the constitution. For 
instance, if the power of a chancre to contaminate the constitution 
in four weeks is equal to four, and the quantity of mercury necessary 
to be given internally, both for the cure of the chancre and the pre- 
servation of the constitution, is also equal to four, then whatever 
shortens the duration of the chancre must lessen, in the same propor- 
tion, the quantity of the mercury; therefore, if local applications, 
along with the internal use of mercury, will cure the chancre in three 
weeks, then only three-fourths of the mercury is necessarily wanted 
internally. Local applications, therefore, so far as they tend to shorten 
the duration of a chancre, shorten the duration of absorption, which 
also shortens the necessity of the continuance of an internal course 
of mercury, all in the same proportion. For example, if four ounces 
of mercurial ointment will cure a chancre, and preserve the consti- 
tution, in four weeks, three ounces will be sufficient to preserve the 
constitution, if the cure of the chancre can be by any other means 
forwarded, so as to be effected in three weeks. This is not specula- 
tion; but the result of experience: and the destruction of chancres 
confirms it. 



We have already considered the arguments contained in the first 
paragraph of this chapter. To speak in common language, the ac- 
tion excited in gonorrhoea is only an altered secretion — in chancre, 
it is ulceration. By analogy, if we dare trust to analogy in any pa- 
thological reasoning, we might suppose that each action, however dif- 
ferent, yet, having been excited by a similar cause, must be super- 
seded by similar means. If this cannot be brought to proof, in the 
present instance, yet the contrary position is equally destitute of 
proofs for, besides the impossibility of distinguishing the venereal 
from other gonorrhoeas, many of the cases produced by Mr. Huntei 
himself shew the difficulty of curing some gonorrhoeas, and that they 
retain their virulence, that is, that the action of secreting virulent 
matter continues after all inflammation has ceased, and nothing re- 
mains but (he gleet. 

I shall make very few remarks on this section, because we shall 
presently see, that Mr. Hunter considers the internal use of mercury 
as necessary in chancre, be the external applications whatever they 
may. The chief use of topical remedies to chancres seems to be, 
that ulcerated parts are good surfaces for absorption, so that, by the 
application of mercury to them, we mav forward the (fleet necessary 
to be excited in the constitution, as will be explained hereafter. But 



212 OF CHANCRE. CHAP. III. 

it will sometimes happen, from causes before mentioned, that a new 
action shall take place in the surrounding parts. In all such cases we 
must conduct ourselves according to circumstances. The directions 
given by Mr. Hunter are as copious as can be required. If they do 
not comprehend every contingency, which could scarcely be possible, 
they contain all the general principles, and the industry of the prac- 
titioner will teach him their application on any new case which may 
occur. 



SECTION I 

Of the Destruction of a Clianvi\. 

The simplest method of treating a chancre is by destroying or ex- 
tirpating it, whereby it is reduced to the state of a common sore or 
wound, and heals up as such. This only can be done on the first ap- 
pearance of the chancre, when the surrounding parts are not as yet 
contaminated; because it is absolutely necessary that the whole dis- 
eased part should be removed, which is done with difficulty when it 
has spread considerably. It may be done either by incision or by 
caustic. If the chancre appears upon the glans, touching it with the 
lunar caustic is preferable to incision, because the haemorrhage by 
such a mode would be considerable, from the cells of the glans. 

The common sensation of the glans is not very acute, therefore 
the caustic will give but little pain. The caustic to be used should 
be pointed at the end like a pencil, that it may only touch those parts 
that are really diseased; this treatment should be continued till the 
surface of the sore looks red and healthy after having thrown off the 
last sloughs; after it has arrived at this state, it will be found to heal 
like any other sore produced by a caustic. 

If the sore is upon (lie prepuce, or upon the common skin of the 
penis, and in its incipient state, the same practice may be followed 
with success; but if it has spread considerably, it is then out of the 
power of the caustic, when only applied in this slow manner, to go 
so deep as to keep pace with the increasing sore; but it is very pro- 
bable that the lapis septicus may answer very well in such cases. 
When this cannot be conveniently used, incision will answer the pur- 
pose effectually. 

I have taken out a chancre by dissection, and the sore has healed 
up with common dressings. However, as our knowledge of the ex- 
tent of the disease is not always certain; and as this uncertainty in- 
creases as the size of the chancre, it becomes necessary in some de- 
gree to assist the cure by proper dressings, and therefore it may be 



SECT. II, OP CHANCRE. 213 

prudent to dress the sore with mercurial ointment. From such treat- 
ment there is hut little danger of the constitution being infected, espe- 
cially if the chancre has been destroyed almost immediately upon its 
appearance, as we may then reasonably suppose there has not been 
time for absorption. But as it must be in most cases uncertain whe- 
ther there has been absorption or not, this practice is not always to 
be trusted to; and from that circumstance, perhaps, never should; 
and therefore even in those cases where the chancre has been removed 
almost immediately, it would be prudent to give some mercury in- 
ternally; the quantity of which should be proportioned to the time 
and progress of the sore; but if it has spread to a considerable size 
before extirpation, then mercury is absolutely necessary, and perhaps 
not a great deal is gained by the extirpation 



SECTION II. 

Of the Cure of Chancres — LocalJlpplicatwn*. 

The cure of a chancre is a different thing from its destruction, 
and consists in destroying its venereal disposition; which being ef- 
fected, the parts heal of course as far as they are venereal. 

Chancres may be cured in two different ways, either by external 
applications or internal, through the circulation. The same medi- 
cine is necessary for both these purposes — that is, mercury. 

I have shown that a gonorrhoea and a chancre have so far the same 
disposition as to form the same kind of matter; yet I have also ob- 
served that mercury has no more power in curing the gonorrhoea than 
any other medicine; and therefore it might be supposed, that mercury 
would have no effect in the present complaint; but we find that in a 
chancre it is a specific, and will cure every one that is truly vene- 
real; but as other dispositions take place, so other assistance is often 
necessary, as will be taken notice of in the history of the cure. The 
action of this medicine must be the same, in whatever way it is 
given, for its action must be upon the vessels of the part, in one way 
acting only externally, in the other internally.* 

* This is well illustrated by the application of some medicines locally to parts 
whose actions are immediate and visible; and by throwing the same medicine 
into the constitution, the same immediate and visible effect is produced ; for in- 
stance, if ten grains of ipecacuanha are thrown into the stomach of a dog, it 
will in a short time make him vomit, from its local applications to that viscusj 
and if a solution of five grains is thrown into a vein, it will produce vomiting 
before we can conceive it to have got to the vessels of the stomach. The 
same effects are produced from an infusion of jalap thrown into the veins, that 
are commonly produced when taken into the stomach and bowels 



214 OF CHANCRE. CHAP. Ill, 

For external local applications, mercurial ointments are the com- 
mon dressings; but if the mercury were joined with watery sub* 
stances instead of oily, by mixing with the matter, the application 
would be continued longer to the sore, and would prove more effec- 
tual. This is an advantage that poultices have over common dress- 
ings. I have often used mercury rubbed down, with some conserve, 
in the room of an ointment, and it has answered extremely well. Ca- 
lomel, used in the same way, and also the other preparations of mer- 
cury, mixed with mucilage or with honey, answers the same pur- 
pose. Such dressings will effect a cure in cases that are truly vene- 
real; but perhaps we seldom have a constitution quite free from some 
morbid tendency. 

Some will have an indolent disposition, to counteract which it will 
be right to join with the mercury some warm balsam in a small pro- 
portion, or as much red precipitate as will only stimulate, without 
acting as an escharotic; and sometimes both may be necessary. 

Calomel mixed with some salve, or any other substance which will 
suspend it, is more active than common mercurial ointment, and, in 
such cases as require stimulating applications, it will answer better. 

Many other applications are recommended, such as solutions of 
blue vitriol, verdigris, calomel, with the spiritus nitri dulcis, and 
many others. 

But as all of these are only of service in remedying any peculiar 
disposition of the parts, having no specific power on the venereal 
poison; and as such dispositions are innumerable, it becomes almost 
impossible to say what will be effectual in every disposition; some 
will answer in one state of the sores, some in another. It may 
be found oftentimes that the parts affected are extremely irritable; in 
such cases it will be necessary to mix the mercury with opium, or 
perhaps preparations of lead, as white or red lead, to diminish the 
action of the parts. 

The oftener the dressings are shifted the better, as the matter from 
the sore separates the application from the diseased parts, by which 
means the effects are lost, or diminished. Three times every day in 
many cases is not oftener than necessary, especially if the dressings 
are of the unctuous kind, for they do not mix like watery dressings 
with the matter, so as to impart some of their virtues to it, which 
would, in a proportional degree, affect the sore. 

Chancres, after having their venereal taint corrected, often become 
stationary, and having acquired new dispositions, increase the quan- 
tity of disease in the part, as will be taken notice of hereafter. When 
they become stationary only, they may often be cured by touching 
them slightly with the lunar caustic. They seem to require that the 
surface which has been contaminated, or the new flesh which grews 
upon that surface, should be either destroyed, or altered, before it can 
cicatrize; and it is surprising often how quickly they will heal after 
being touched; and, probably, once or twice may be sufficient. 



SECT. III. OF CHANCRL. 2 1 .'» 



SECTION III. 

Of the Treatment of Pkymosis in consequence of, or attended vrith, 
Chancre. 

From the history which I have given of the disease, we must see 
that a phymosis may be of two kinds, one natural, with the disease 
superadded, the other brought on by disease. The first may be in- 
creased by the disease; but, if otherwise, it is not so troublesome as 
the other. Such phymosis, as arise from the disease, I have ob- 
served, depend upon the peculiarity of the constitution. In either 
case it is often not practicable to apply dressings to the chancres on 
the inside of the prepuce. 

A phymosis should be prevented, if possible; therefore, upon the 
least signs of a thickening of the prepuce, which is known by its 
being retracted with difficulty and pain, the patient should be kept 
quiet; if in bed so much the better, as in an horizontal position the 
end of the penis will not be so depending, but may be kept up. If 
confinement in bed cannot be complied with, then the end of the pe- 
nis should be kept up to the belly, if possible; but this can hardly be 
done when the person is obliged to walk about; for the extravasated 
fluids, descending and remaining in the prepuce, contribute often 
more to render the prepuce incapable of being drawn back than the 
inflammation itself. 

When the diseased phymosis completely takes place, the same 
precautions may be followed; but as the sores cannot be dressed in 
the common way, we must have recourse either to dressings in forms 
of injections, or the operation for the phymosis. If we use injec- 
tions only, they should be often repeated, as they are only temporary 
applications. 

The dressings, in form of injections, should be mercurial, either 
crude mercury rubbed down with a thick solution of gum arabic. 
which will assist in retaining some of the injection between the glan^ 
and prepuce, or calomel with the same, and a proportion of opium. 
In the proportion of these no nicety is required; but if a solution of 
corrosive sublimate is made use of as an, injection, some attention is 
to be paid to its strength. About one grain of this to an ounce of 
water will be as much as the sensation of the part will allow the pa- 
tient to bear; and if this gives too much pain, it may be lowered by 
adding more water. 

After the parts are as well cleaned as possible with this injection, 
it will be necessary to introduce other mercurial applications, of 
some kind, to remain there till the parts want cleaning again, which 
will be very soon. Such as are mentioned before will answer this 



21G OF CHANCRE. CHAP. III. 

purpose verj well; but 1 have my doubts about the propriety of using 
any irritating medicines or injections in such cases. 

As often as he voids his urine, the patient may wash the parts, by 
pressing the orifice of the prepuce together, so as to oblige the water 
to run back between the prepuce and glans; immediately after this 
the patient should use the mercurial applications, otherwise this 
operation of washing may do harm, as it will wash away the former 
application of mercury; but in many cases the parts are so sore as 
not to allow of this practice. 

A poultice of linseed meal alone, or of equal parts of this and 
bread, should be applied. This poultice is to be made with water, 
to which one-eighth of laudanum has been added; but previous to 
this, and immediately after the cleaning, it would be very proper to 
let the penis hang over the steam of hot water, with a little vinegar 
and spirits of wine in it, which is the neatest way of applying fo- 
mentations. 

The oftener this is practised the better; for thus a mercurial ap- 
plication is kept in contact with the diseased parts a greater number 
of the hours out of the twenty-four than otherwise could be, were 
the matter allowed to lie on the parts. 

When to the above-mentioned symptoms a bleeding of the chan- 
cre is added, I do not know a more troublesome complaint, because 
here the cells or veins have no great disposition for contraction.* 
Oil of turpentine gives the best stimulus for the contraction of ves- 
sels of all kinds; but where bleeding arises from an irritable action 
of the vessels, which is sometimes the case, then sedatives are the 
best applications. Whatever is used in such a state of the prepuce 
must be injected into the part. 

When, in consequence of the treatment, the inflammation begins 
to go off, and the chancres to heal, it will be necessary to move the 
prepuce upon the glans as much as they will allow of, to prevent ad- 
hesions, which sometimes happen, when there have been chancres 
on both surfaces opposite to each other. Indeed the practice here 
recommended is such as will in general prevent such consequences. 

If this has not been properly attended to, and the parts have grown 
together, the consequences may not be bad; but it must be very dis- 
agreeable to the patient, and a reflection upon the surgeon. 

I have seen the opening into the prepuce so much contracted from 
all these internal ulcers healing and uniting, that there was hardly 
any passage for the water. If the passage in the prepuce so con- 
tracted be in a direct line with the orifice of the urethra, then a bou- 

* I suspect that where chancres bleed profusely, the blood comes either from 
the glans, when there are chancres there, or from the spongv suhstance of the 
urethra where the chancre lias begun about the framum; for we seldom see pro- 
tuse bleedings from the prepuce when its inside is the seat of the chancre, and 
can be exposed ; but, indeed, in such cases the inflammation is not violent. 



SECT. IV. OP CHANCRE. ^1* 

gie may be readily passed; but this is not always the case: it often 
happens that they are not in a direct line, therefore an operation be- 
comes necessary. The operation consists in either slitting up part 
of the prepuce, or removing part of it; but as these parts have be- 
come very indistinct from the adhesions, either the slitting it up, or 
removing part of it, becomes a difficult operation. Whenever the 
urethra is discovered, or can be found out by a bougie, that is to be 
introduced, and its application repeated, till the passage becomes 
free, and has got into the habit of keeping so. 

I observed formerly, that this tumefaction sometimes produced a 
confinement of the matter formed by the chancre, and that while this 
effect lasted, no subsiding of the inllammation, or tumefaction, could 
take place; that therefore those diseases continued to exist, and that 
the part thus eircumstanced came under our definition of an abscess; 
that is, the formation of matter in a state of confinement. Although 
it never has been considered in this light, yet the necessary treatment 
shows it to be such. This consists in laying it open from the exter- 
nal orifice to the bottom, where the matter lies, as in a sinus, or fis- 
tula, so as to discharge it. However, the intention annexed to this 
practice was, not to allow of the discharge of the matter of the sore, 
but to admit of the applications of dressings to it, for it has been re- 
commended and practised, where there was no particular confine- 
ment of matter, which I have not found to be necessary, merely for 
that purpose, as we are in possession of an internal remedy; and if 
the opening produces no other good but the allowing of the applica- 
tion of dressings, it is not so material, because the sores may be wash- 
ed with an injection through a syringe. 



SECTION IV. 

Of the common Operation for the Phymosis produced by Chancres. 

The common operation for the phymosis is slitting the prepuce 
nearly its whole length, in the direction of the penis; but even this 
is sometimes thought not sufficient, and it is directed to cut the pre- 
puce in two different places, nearly opposite to one another. When 
it was thought proper to be done in this way, it was imagined that it 
was seldom necessary to cut the whole length of the prepuce. It will 
in some- degree depend on circumsiances which practice is to be 
followed. If it is a natural phymosis, without tumefaction, and the 
chancre is near the orifice of the prepuce, which in such cases it 
most probably will be, as the glans is not denuded in coition so as to 

E e 



318 OF CHANCRE. CHAP. III. 

have chancres deeper seated, then it may be necessary only to go as ' 
far as the chancres extend. 

From the common situation of the chancre, this disease of the 
phymosis arises more commonly from the tumefaction of the parts; 
and from the idea I have endeavoured to give of the inconveniences 
arising from this phymosis, where the chancres are placed behind the 
corona, producing a confinement of the matter behind the glans, slit- 
ting open the prepuce a little way cannot be sufficient, for in such 
cases it must be exposed to the bottom, or no good can arise from the 
operation. 

Although this operation will not take off the tumefaction of the 
prepuce so as to allow it to be brought back, yet it will allow of a 
free discharge of the matter, and also, in some cases, it will allow of 
dressings being applied to the sores; but not in all, for the tumefac- 
, tion will not now allow more of an inversion of the prepuce than 
before, and in such the sores cannot have dressings applied to them. 

In many cases it will be found that so violent an operation is im- 
proper; for it often happens, that while the inflammation is so very 
considerable, there is danger of increasing it by this additional vio- 
lence, of which mortification may be the consequence; while, on the 
other hand, there are cases where a freedom given to the parts would 
prevent mortification; so that the surgeon must be guided by the ap- 
pearances, and other circumstances. Besides these reasons for and 
against the operation, arising from the disease itself, it will not al- 
ways be consented to by the patients themselves; for some have such 
a dread of operations, that they will not submit to cutting instru- 
ments; however, in those cases where the matter is confined, it will 
be absolutely necessary to have an opening somewhere for the dis- 
charge of it. This is often produced by the ulcerative process going 
on on the inside, which makes an opening directly through the skin, 
laterally, which affords a direction for the surgeon; therefore the 
opening may be made directly into the cavity of the prepuce, through 
the skin, on the side of the penis, by a lancet; or a small caustic 
may be applied there, for which the lapis septicus is the most con- 
venient. 

The opening will allow of the discharge of the matter, and also 
admit any proper wash to be thrown in: but this opening should not 
be a large one, as, in many cases, the consequence of this lateral 
opening proves very troublesome; for, from the tumefaction of the 
prepuce, the glans is squeezed on all sides, and rather more back- 
wards upon the body of the penis than in any other direction, by 
which means it is often forced through this opening, whereby the 
glans is directed to one side, and the prepuce to the opposite, having 
a forked appearance. Besides, this state of the parts tightens the 
skin of the penis round the root of the glans, acting there somewhat 
like a paraphymosis, and sometimes makes the whole prepuce mor- 
tify and drop off, which is often a lucky circumstance; but if this i* 



SECT. V. OF CHANCRE. 219 

not the consequence, then amputation of the prepuce becomes ne- 
cessary; however, this should not be done till all inflammation is 
gone off, and the chancres are cured, when, probably, the tumefac- 
tion of the prepuce will have considerably subsided. 

A mortification of the prepuce is sometimes a consequence of 
chancres, when attended with violent inflammation, even without 
any previous operation; and I have seen cases where the glans and 
part of the penis have mortified, while the prepuce has kept its 
ground. But I should suspect, in all such cases, that there is some 
fault in the constitution; and that the inflammation is of the erysi- 
pelatous, not of the true suppurative kind. 

I have seen the mortification go so far as to remove the whole of 
the diseased prepuce; and the parts have put on so favourable an 
appearance, that I have treated it as a common sore, and no bad 
consequences have happened. In this case, the disease performed 
what is often recommended in other diseases of this part, that is 
circumcision; but this is not always to be trusted to; for, if absorp- 
tion of the venereal matter has taken place, previous to the mortifi- 
cation, a lues venerea will be the consequence, although the part< 
heal very readily. 



SECTION V. 

Of the Constitutional Treatment of Phymosis. 

In those cases where violent inflammation has attacked the seat 
of a chancre, producing phymosis, as before described, and often so 
as to threaten mortification, a. question naturally occurs — what is to 
be done? Is mercury to be given freely, to get rid of the first cause? 
or, does that medicine increase the effect, while it destroys the cause? 
— Nothing but experience can determine this. I should incline to 
believe, that it is necessary that mercury should be given; fori am 
afraid our powers to correct such a constitution, while the first cause 
subsists, are weak; however, on the other hand, I believe the mercury 
should be given sparingly; for, if it assists in disposing the constitu- 
tion to such symptoms, we are gaining nothing, but may lose by its 
use. I therefore do suppose, that such medicines as may be thought 
necessary for the constitution should be given liberally, as well as 
the specific. Bark is the medicine that probably will be of most ge- 
neral use; opium, in most cases of this kind, will also be of singular 
service. The bark should be given in large quantities, and along 
with it mercury, while the virus is still supposed to exist: or, if the 
inflammation has arisen early in the disease, they may be then given 



220 OF CHANCRE- CHAP. III. 

together, so as to counteract both diseases, and not allow the inflam- 
mation to come to so great a height as it would otherwise do, if mer- 
cury was given at first alone. This inflammation may be go great in 
many cases, or be so predominant, that mercury may increase the 
disposition, and therefore become hurtful. Where this may be sup- 
posed to be the case, bark must be given alone. 



SECTION VI. 

Of the Treatment of the Paraphimosis from Chancres. 

A prepuce in the state of inflammation and tumefaction, and which 
ha a be en cither kept back upon the body of the penis while inflaming, 
or pulled back when inflamed, seldom can be again brought for- 
wards while in this state, therefore becomes also the subject of an 
operation; which consists in dividing the same part, as in the phy- 
mosis, only in a different way, arising from its difference of situation; 
the intention of which operation is to bring the prepuce, when 
brought forwards, to the state of a phymosis that has been operated 
upon. This operation becomes more necessary in many cases, un- 
der this disease, than under the phymosis, because its consequences 
are generally worse; since, besides the real disease, viz. inflamma- 
tion, tumefaction, ulceration, &c. there is a mechanical cause pro- 
ducing its effects; by grasping the penis, which can of itself produce 
inflammation where the prepuce is naturally tight, as has been observ- 
ed. From whatever cause it arises, it often produces mortification in 
the parts between the stricture and the glans, if it is not removed. 
This removal sometimes happens naturally by the ulceration of the 
strictured part; but an operation is generally necessary; and it is 
more troublesome than in the former case, because the swelling on 
each side of the stricture covers or closes in upon the tight part, and 
makes it difficult to be got at. 

The best way appears to be, to separate the two swellings as much 
as possible where you mean to cut, so as to expose the neck, then take 
a crooked history which is pointed, and passing it under the skin at 
the neck, divide it; no part of the two swellings on the sides need be 
divided, for it is the looseness of the skin in these parts which ad- 
mits of their swelling. When this is done the prepuce may be 
brought forwards over the glans; but as this disease arose from chan- 
cres which may require being dressed, and as the state of a phymosis 
is a very bad one for such treatment, it may be better, now that the 
stricture is removed, to let it remain in the same situation till the whole 
is well. 



SECT. VII. OP CHANCRE. 221 

If the paraphymosis has arisen from a natural tightness of the pre- 
puce, and its being forced back from accident, then no particular 
treatment after the operation is necessary, but to go on with the cure 
as recommended in chancres. It is indeed probable, that, in conse- 
quence of the violence produced by the position of the prepuce, as 
also by the operation, a considerable inflammation may ensue; but 
as this will be an inflammation in consequence of violence only, 
local treatment for the inflammation will be sufficient. 

But if it is a paraphymosis in consequence of a diseased phymosis, 
then the same mode of treatment becomes equally necessary as was 
recommended in the phymosis, attended with considerable inflamma- 
tion; and probably rather more attention is necessary here, as vio- 
lence has been added to the former disease. 



SECTION VII. 

Of the Cure of Chancres by Mercury, given internally. 

While chancres are under local treatment, as before described, it 
is necessary to give mercurials internally, both for the cure of the 
chancre and the prevention of a lues venerea; and we may reasonably 
venture to affirm, that the venereal disposition of chancre will hardly 
ever withstand both local and internal mercurials. 

In cases of chancres, where local applications cannot easily be 
made, as in cases of phymosis, internal mercurials become absolutely 
necessary; and more so than if they could be conveniently and freely 
applied externally. However, even in such cases, internal mercu- 
rials will in the end effect a cure; so that we need seldom or ever 
be under any apprehension of not curing such a disease. 

In every case of a chancre, let it be ever so slight, mercury should 
be given internally; even in those cases where they were destroyed 
on their first appearance. It should in all cases be given the whole 
time of the cure, and continued for some time after chancres are 
healed; for as there are perhaps few chancres without absorption 
of the matter, it becomes absolutely necessary to give mercury to 
act internally, in order to hinder the venereal disposition from 

forming. .... 

How much mercury should be thrown into the constitution in the 
cure of a chancre, for the prevention of that constitutional affection, 
is not easily ascertained; as there is in such cases no disease actually 
formed so as to be a guide, it must be uncertain what quantity should 
be given internallv. It must, in general, be according to the size, 
number and duration of the rhancres. If large, we may suppose 



222 OF CHANCRE. CHAP. III. 

that the absorption will be proportioned to the surface; and if long 
continued, the absorption will be according to the time; and if they 
have been many, large, and continued long, then the greatest quantity 
is necessary. 

The circumstances,' therefore, attending the chancre must be the 
guide for the safety of the constitution, especially in those cases 
where some stress in the cure is laid upon the external remedy. 

The mercury given to act internally must be thrown in either by 
the skin or stomach, according to circumstances. 

The quantity, in either way, should be such as may, in common, 
affect the mouth slightly; which method of giving mercury will be 
considered hereafter. 

When the sore has put on a healthy look; when the hard basis has 
become soft, and it has skinned over kindly, it may be looked upon 
as cured. 

But in very large chancres it may not always be necessary to con- 
tinue the application of mercury, either for external or internal action, 
till the sore is healed; for the venereal action is just as soon destroyed 
in a large chancre as it is in a small one; for every part of the 
chancre being equally affected by the mercury, is equally easily cured: 
but the skinning is different; for a large sore is longer in skinning 
than a small one. A large chancre, therefore, may be deprived of 
its venereal action long before it is skinned over; but a small one may 
probably skin over before the venereal poison is entirely subdued. 
In the latter case, both on account of the chancre and constitution, it 
will be erring on the safe side, to continue the medicine a little longer, 
which will, most certainly, in the end, effect a cure: for we may 
reasonably suppose, that the quantity of mercury capable of curing 
a local effect, although assisted by local applications, or of producing 
in the constitution a mercurial irritation, sufficient to hinder the ve- 
nereal irritation from forming, will be nearly as much as will cure a 
slight lues venerea. 

I have formerly laid it down as a principle, that no new action 
will take place in another part of the body, however contaminated, 
whilst the body is under the beneficial operation of mercury; but 
there are now and then appearances Avhich occur under the cure, that 
will, at first, embarrass the practitioner. I have suspected, that the 
mercury, flying to the mouth and throat, has sometimes produced 
sloughs in the tonsils; and these have been taken for venereal. The 
following cases, in some degree, explain this: — 

A young gentleman had a chancre on the prepuce, with a slight 
pain in a gland of one groin, for which I ordered mercurial ointment 
to be rubbed into the legs and thighs, especially on the side where 
the gland was swelled, and the chancre to be dressed with mercurial 
ointment. While he was pursuing this course, the chancre became 
cleaner, the hardness at the base went off, and the pain in the groin 
was entirely removed. About three weeks after the first appearance 



SECT. VII. 0F CHANCRE. 22J 

of the disease, he was attacked with a sore throat; and on looking 
into the mouth, I found the right tonsil with a white slough, which 
appeared to be in its substance, with only one point yet exposed. 
From my mind being warped by the opinion that these complaints 
proceeded from the chancre, I immediately suspected that it was vene- 
real; and the only way that I could account for this seeming contra- 
diction, in one part healing, while another was breaking out, was, 
that the healing sore was treated locally as well as constitutionally, 
while the tonsil, or the constitution at large, was only treated consti- 
tutionally; which was insufficient. 

Soon after this, another gentleman was under my care, for vene- 
real scurfs, or eruptions, on his skin, for which he used mercurial 
friction, till his mouth became sore; and in this state he continued 
for three weeks, in which time the eruptions were all gone, disco- 
lourations being left only where the eruptions had been; yet at the 
end of three weeks a slough formed in one of the tonsils, exactly as 
in the former case. This made me doubtful how far such cases 
were venereal. I ordered the friction to be left off, to see what 
course the ulcers would take; the slough came out, and left a foul 
sore: I waited still longer, and in a day or two it became clean, and 
healed up. 

The first-mentioned case I did not see to an end; but I learned 
that the patient continued the mercury, and got well: and the ulcer 
in the throat was supposed to be venereal; but from the circum- 
stances of the other case, I now very much doubt of that. 

It is more than probable, that these effects of mercury only take 
place in constitutions that have a tendency to such complaints in the 
throat. I know this to be the case with the last-mentioned gentle- 
man; and it is also probable, that there may be an increased dispo- 
sition at the time, either in consequence of the mercury, or some ac- 
cidental cause. I have reason to suppose, that mercury, in some 
degree, increases this disposition, which I shall further take notice of 
when treating of the cure of the lues venerea. 

In the cure of chancres I have sometimes seen, when the original 
chancre has been doing well, and probably nearly cured, that new 
ones have broken out upon the prepuce, near to the first, and have 
put on all the appearance of a chancre; but such I have always 
treated as not venereal. They may be similar to some consequences 
of chancres, which will be taken notice of hereafter. 

As swellings of the absorbent glands take place in consequence of 
other absorptions besides that of poisons, we should be careful, in all 
cases, to ascertain the cause, as has been already described; and 
here it may not be improper still to observe further, that in the cure 
of chancres, swellings of the glands shall arise, even when the con- 
stitution is loaded with mercury sufficient for the cure of the sores; 
but when the mercury has been thrown into the constitution by the 
lower extremity; and, therefore, there is great room for suspicion 



224 OF CHANCRE. CHAP. III. 

that such swellings are not venereal, but arise from the mercury; 
for a real bubo, 4Yom absorption of venereal matter, if not come to 
suppuration, will give way to mercury rubbed into the leg and thigh. 
In such cases I have always desisted from giving the mercury in this 
way when I could give it by the mouth. 



This most important chapter is most unhappily obscured, partly 
by an awkward reference to past passages, but principally by occa- 
sional anticipation of a theory which is not developed till the latter 
part of the work; in which the laws of the disease, arising from ab- 
sorption, are considered. 

As Mr. Hunter urges the necessity of using mercury internally, 
that is, by friction or the mouth, in all cases of chancre, we must 
admit, that it is not easy for him to ascertain what effect he produced 
by external, or topical remedies. He urges, that " there are, per- 
haps, few chancres without absorption of matter." It is certain, that 
there can be none; for what is ulceration but absorption of the dis- 
eased part? But absorption is not necessarily followed by contami- 
nation, as we shall see hereafter. 

" The circumstances," he observes, " attending the chancre, 
must be the guide for the safety of the constitution." One should 
suppose by this, that we might form some rational conjectures con- 
cerning the probability of preserving the constitution. We shall see, 
hereafter, how uncertain every conjecture has hitherto been; even if 
they were more rational, it would be impossible to comprehend Mr. 
Hunter's meaning, till we arrive at the passage before mentioned, 
where the subject is taken up in its order. 

In this place, therefore, I should wish the reader to confine his 
attention to the cure of the chancre, or the primary local ulcer; and 
most of the rules here given are applicable to that only. 

" Mercury given to act internally," it is added, " is thrown in 
either by the skin or the stomach, and, in common, should be con- 
tinued till the mouth is slightly affected." 

In common this is sufficient; because, when the mouth is slightly 
affected by mercurial friction, the irritation will increase, and if the 
chancre is not of long standing it will readily heal. But " the cir- 
cumstances attending the chancre must be the guide:" — when this 
has lost its hard edge and base, and looks red, it will soon skin over. 
From the time that the surface of a chancre begins to look cleaner, 
or redder, the practitioner should be particularly frequent and accu- 
rate in his examination of the part. If the sore has been very small, 
and recent, it may skin over almost immediately; but then the skin 
will sometimes be found to have started over the elevated side and 
hard base. This, therefore, he must not trust to; but continue his 
mercurial frictions till the hardness is absorbed; and the skin will 
then line the little cavity which is made by the loss of substance. 



SECT. VII. OF CHANCRE. 225 

If the chancre is of longer standing, the effect of mercury on the 
constitution must be proportionally great to produce a cure; nor will 
there be any danger of the part skinning over before it is perfectly 
sound; because the diseased surface will be so extensive, and the 
diseased habit so confirmed, that no curative process will be at- 
tempted by the parts (ill the mercurial irritation is very highly ex- 
cited, and long continued. 

In that state the chancres will become clean, and often remain 
nearly stationary till the constitution begins to recover from the mer- 
curial irritation: though, therefore, the excitement should be high, 
it need not be continued till the sore is healed. 

The reader will observe, that in all this time I have said nothing 
about the quantity of mercury to be used, or the mode of introducing 
it. Mr. Hunter has reserved that question till the conclusion of his 
account of the disease in all its stages, we must therefore reserve our- 
selves for that place. I cannot, however, conclude this passage on 
the cure of chancre without a remark or two. 

The effect produced on the constitution, and not the quantity of 
mercury introduced, appears to me, from the closest examination, the 
only means by which the cure is produced. The sooner such effect 
is induced, therefore, the better; but some caution is necessary the 
first time a patient uses mercury, because there are certain constitu- 
tions which are very early and very violently affected by very small 
quantities. But however sudden such effect may be, the conse- 
quences, as to cure, are not less certain; the only caution, therefore, 
that is necessary is, lest we should produce so high an irritation as 
we cannot easily subdue, and not lest we should cure our patient too 
soon. 

Another remark I would make on the manner in which chan- 
cres, and, indeed, the primary ulcers, induced by all morbid poisons, 
heal. 

If the reader will turn to page 214, he will see a short remark on 
the treatment of a " chancre when its venereal taint is corrected, 
yet it does not heal, because it has acquired a new disposition, or is 
become stationary:' The new disposition will be considered in a 
subsequent chapter. But when they become stationary, Mr. H. re- 
marks, " they seem to require that the surface which has been con- 
taminated, or the new flesh which grows upon that surface, should be 
destroyed or altered before it can cicatrize;" after which, he adds, it 
is surprising how quickly they will cicatrize. In this passage, we 
may remark that he uses the term new flesh, though without calling it 
granulations] and also the term cicatrix. But in the section which 
we are now considering he carefully avoids all these terms, and 
uses no other than damning over. This is a striking proof of his 
great caution in describing exactly what he saw, though he was not 
•marc that he was tracing a law which is peculiar to the mode of 
healing in morbid poisons. 



226 OF CHANCRE. CHAP. HI. 

A loss of substance from a morbid poison is never restored by 
granulations; the parts either skin over as soon as ulceration ceases, 
or a fungus arises from the surface. In the last case, the new Jlesh, 
a* Mr. Hunter with his usual caution calls it, not being healthy gra- 
nulation, cannot cicatrize, but as soon as its surface is altered, it 
heals like any other part. This fungus is more apt to arise where 
the natural action of the parts is interrupted by dressings; it is there- 
fore very properly noticed by Mr. Hunter in that passage in which 
he speaks of the attempts at curing chancres by topical means. 

If the parts are left more to themselves, they will for the most 
part heal with greater rapidity than common ulcers; because they 
have not the granulating process to pass through, nor the formation 
of new skin to complete the cicatrization, but the surrounding cuticle 
at once extends over the cavity so as to line it without any alteration 
in its figure. 

The remainder of this section is occupied in a very important 
discussion, which the practitioner should always keep in view, name- 
ly, certain appearances near the seat of the chancre, and in other 
parts of the body, which arise whilst the constitution shows the mer- 
curial irritation; and even whilst the chancre is showing a disposi- 
tion to heal by becoming cleaner and redder. Whatever these ap- 
pearances may be, we may rest assured that they are never venereal, 
and for the most part that they will cease with the mercurial irritation. 
I shall only notice those which arise round the chancre. They are 
what Mr. Hunter refers to in page 223, under the name of future or 
consequent ulcers, which, he says, are easily distinguished from the 
original or venereal ulcer. In the present passage, he says, " When 
the original chancre is nearly healed, I have seen new ones [ulcers] 
break out near to the first, and put on all the appearance of chan- 
cres." Mr. Hunter adds, he has never treated them as venereal: 
of course he has never found it necessary. It should be remarked 
that this similarity in appearance is not of the chancre in its full 
character, as is explained in page 201, where the subject is again 
taken up in a section on ulcerations resembling chancres. I very 
much suspect that these ulcers are the effect of contamination on 
parts which would have become chancres had not the mercurial 
course prevented it. In such cases, irritation from the virus may 
have produced a change in the parts from which they cannot recover 
Without first ulcerating. I am the more confirmed in this, because 
all the cases I have seen have been those in which the chancre has 
been attended to in its earliest stage, probably before others have 
shown themselves, which would have appeared had not the mercu- 
rial process prevented them. 



CHAP. V. 



OP CHANCRE. 227 



CHAP. IV. 



Of the Cure of Chancres in Women. 

The parts generally affected with chancres in this sex are more 
simple than in men, by which means the treatment in general is also 
more simple; but in most cases they require nearly the same, both 
in the local application of mercury, and in throwing it into the con- 
stitution. It may be supposed, however, that it will be necessary in 
many cases to throw into the constitution more mercury than in men; 
because in general there are more chancres, and the surface of ab~ 
sorption of course larger. 

As it is difficult to keep dressings on the female parts, it is proper 
they should be washed often with solutions of mercury; perhaps cor- 
rosive sublimate is one of the best, as it will act as a specific, and 
also as a stimulant when that is wanted; but in chancres that are very 
irritable, the same mode of treatment as was recommended in men 
is to be put in practice. Afterwards the parts may be besmeared with 
mercurial application, either oily or watery, to be frequently repeat- 
ed according to the circumstances of the case. 

If the ulcers should have spread, or run up the vagina, great at- 
tention should be paid to the healing of them; for it sometimes hap- 
pens that the granulations contract considerably, so as to draw the 
vagina into a small canal; at other times the granulations will unite 
into one another and close the vagina up altogether; therefore 
in such cases it will be necessary to keep some substance in the 
vagina till the sores are skinned, for which purpose probably lint may 
be sufficient. 



CHAP. V. 



Of some of the Consequences of Chancres — and the Treatment 
of them. 

After the chancres have been cured, and all venereal taint re- 
moved it sometimes happens that the prepuce still retains a consi- 
derable degree of tumefaction, which keeps up the elongation and 



OF CHANCRE. CHAP. V. 

tightness which it acquired from the disease, so that it cannot be 
brought back upon the penis to expose the glans. 

For this perhaps there is, in many cases, no cure; however it is 
necessary to try every possible means. The steam of warm water, 
fomentations with hemlock, and also fumigations with cinnabar, are 
often of singular service in this case. 

But if the parts still retain their size and form, it may be 
very proper to remove part of the overgrown prepuce; how much, 
must be left to the discretion of the surgeon. I should suppose 
that all that part which projects beyond the glans penis may be cut 
away. 

The best way of removing it is by the knife; but great care should 
be taken to distinguish first the projecling prepuce from the glans. 
When this is perfectly ascertained, the penis being held horizontally, 
an incision may be made on the upper surface, and followed down 
with caution; because if the incision should be too near the glans, 
there may be danger of cutting it. 

The parts may be allowed to heal with any common dressings, as 
it is to be considered as a fresh wound; however, it will not heal so 
readily as a fresh wound made in an entirely sound part, because the 
operation consists in taking away only a superfluous part of a diseased 
whole; and what is left is diseased, but not so as to produce any 
future mischief. 

Some care may be necessary in the healing of the parts; for it is 
very possible that the cicatrix may contract, and still form a phimo- 
sis. This will be best prevented by the patient himself if he brings 
the prepuce often back upon the penis; but it should not be at- 
tempted till the part is nearly healed; and it is to be performed with 
great care, and slowly. 



SECTION I. 

Of Dispositions to new Diseases during the Cure of Chancres. 

Chancres, both in men and women, often acquire new disposi- 
tions in the time of cure, which are of various kinds; some of which 
retard the cure, as described, and when the parts are cured, leave 
them tumefied and indolent, as in the enlarged prepuce. In others 
a new disposition takes place, which prevents the cure or healing of 
the parts, and often produces a much worse disease than that from 
which it arose. They also become the cause of the formation of 
tumors on these parts, which will be taken notice of hereafter. 

Such new dispositions take place oftener in men than in women, 



SECT - *• OP CHANCRL. 2^'J 

probably from tbe nature of the parts themselves. They seldom or 
never happen but when the inflammation has been violent, which 
violence arises more from the nature of the parts than the disease, and 
therefore belongs more to the nature of the parts or constitution than 
to the disease. However I can conceive it may also take place where 
the inflammation has not been violent. 

In general they are supposed to be cancerous, but I believe 
they seldom are ; although it is not impossible that some may 
be so. 

Of this kind may be reckoned those continued and often in- 
creased inflammations, suppurations, and ulcerations, becoming 
diffused through the whole prepuce, as also all along the common 
skin of the penis, which becomes of a purple hue; the cellular mem- 
brane every where on the penis being very much thickened, so as to 
increase the size of the whole considerably. 

The ulceration on the inside of the prepuce, will sometimes in- 
crease and run between the skin and the body of the penis, and eat 
holes through in different places till the whole is reduced to a num- 
ber of ragged sores. The glans often shares the same fate till more 
or less of itis-gone; frequently the urethra at this part is wholly de- 
stroyed by ulceration, and the urine is discharged some way further 
back. If a stop is not put to the progress of the disease, the ulcera- 
tion will continue till the parts are entirely destroyed. I suspect that 
some of these cases are scrofulous. 

As this is an acute case, immediate relief should be given, if pos- 
sible; but as it may arise from various peculiarities in the constitu- 
tion, and as these peculiarities are not at first known, no rational 
method can be here determined. The decoction of sarsaparilla is 
often of service in such cases, but requires to be given in large 
quantities. 

The German diet-drink* has been of singular service; I knew a 
case of this kind cured by it, after every known remedy had been 
tried. The extract of hemlock is sometimes of service. I have 
known sea-bathing cure these complaints entirely. A gentleman 
came from Ireland with a complaint of this kind; and after having 
tried every common and known method, without effect, as sarsapa- 

• The following formula: have been much recommended as diet-drinks. 
Take of crude antimony, pulverized, tied up In a bit of rag; pumice-stone, pul- 
verized, tied up in the same, of each one ounce ; China-root, sliced ; sarsaparilla- 
root, sliced and bruised; of each half an ounce; ten walnuts, with their rinds, 
bruised ; spring-water, four pints, boiled to half that quantity ; filter it, and let 
it be drank daily in divided doses. 

Take sareaparilla, Sanders'-wood, white and red, of each three ounces; 
liquorice and mezeron, of each half an ounce; of lignum, rhodium, guaiacum, 
sassafras of each one ounce; crude antimony, two ounces; mix them and in- 
fuse them in boiling water, ten pints, for twenty-four hours ; and afterwards 
boil them to five pints, of which let the dose be from a pint and an half to four 
t/ints a day 



230 OF CHANCRE. CHAP. V. 

rilla, hemlock, German diet-drink, and after having used a great va- 
riety of dressings, (which were all at last laid aside, and opium only 
retained to quiet the pain,) he bathed in the sea and got well. It 
may be sometimes necessary to pass a bougie, to hinder the orifice of 
the urethra from closing or becoming too small in the time of healing 
in such cases. 



SECTION II. 

Of Ulceration resembling Chancres. 

It often happens, that after chancres are healed, and all the virus 
gone, the cicatrices ulcerate again, and break out in the form of 
chancres. 

Although this is most common in the seat of the former chancres, 
yet it is not always confined to them; for sores often break out on 
other parts of the prepuce; but still they appear to be a consequence 
of a venereal complaint having been there, as they seldom attack 
those who never had gonorrhoea or chancres. They often have so ? 
much the appearance of chancres, that I am persuaded many are 
treated as venereal that are really not such: they differ from a chan- 
cre, in general, by not spreading so fast, nor so far; they are not so 
painful, nor so much inflamed, and have not those hard bases that 
the venereal sores have, nor do they produce buboes. Yet a ma- 
lignant kind of them, when they attack a bad constitution, may be 
taken for a mild kind of chancre, or a chancre in a good consti- 
tution. 

Some stress is to be laid upon the account that the patient gives of 
himself; but when there is any doubt, a little time will clear it up. I 
have seen the same appearances after a gonorrhoea; but that more 
rarely happens. It w r ould appear that the venereal poison could 
leave a disposition for ulceration of a different kind from w r hat is pe- 
culiar to itself. I knew one case where they broke out regularly 
every two months, exactly to a day. 

As they are not venereal, their treatment becomes difficult; for 
the cure consists more in preventing a return, than in the healing up 
of the present sores. 

They require particular attention; for although they are not danger- 
ous, they are often troublesome, keeping the mind in suspense for 
months. 

I have tried a great variety of means, but with little success, yet 
they have in general got well in the end. In the following case, the 
lixivium saponarium produced a speedy cure. 



SECT. HI. OF CHANCRE. 231 

A gentleman had three sores broke out on the prepuce, which had 
very much the appearance of mild chancres. As I was doubtful of 
their nature, I waited some time, and only ordered them to be kept 
clean. As they did not get well, several things were tried. Mercu- 
rial dressings were applied, but they always produced considerable 
irritation, and it was necessary to leave them off. The mercurius 
calcinatus was given by way of trial, and to secure the constitution, 
but the sores continued the same. They were eat down by the lunar 
caustic, which appeared to have a better effect than any other thing 
tried; but still they were not healed at the end of five months. I or- 
dered forty drops of the lixivium saponarium to be taken every even- 
ing and morning in a basin of broth. After using it three days, he 
observed a considerable alteration in the sores, and in six they were 
perfectly skinned over. He had formerly had such sores often, which 
had always been treated as venereal; but he began to doubt whether 
they really were so from their getting so soon well, in the present in- 
stance, by the lixivium. 

I knew a gentleman who had these sores breaking out and healing 
again for years. By bathing in the sea for a month or two they heal- 
ed up, and never afterwards appeared. 

Those are the ulcers referred to in page 201 and 226. 



SECTION III. 

Of a Thickening and Hardening of the Parts. 

In some cases the parts do not ulcerate, but appear to thicken and 
become hard or firm; both the glans and prepuce seem to swell, form- 
in- a tumor or excrescence from the end of the penis, in form a good 
deal like a cauliflower, and, when cut into, showing radii running 
from its base, or origin, towards the external surface, becoming ex- 
tremely indolent in all its operations. This gives more the idea of 
a cancer than the first, being principally a new-formed substance. 
However, it is not always a consequence of the venereal disease, ioi 
I have known it to arise spontaneously. 

This disease appears to be a tumor of so indolent a kind, that 1 do 
not know any medicine that stands the least chance of performing a 
cure I have amputated them, and have also seen the same thing 
done bv others, from the idea of their being cancerous, and the re- 
maining Dart of the penis has healed kindly. 

In most of these cases a considerable part of the perns must be re- 



232 OF CHANCRE. CHAP. V. 

moved. Immediately after the amputation, a suitable catheter should 
be introduced into the urethra; for if no such precaution is made use 
of, the consequences must be troublesome; for the first dressings be- 
come cemented to the orifice by the extravasated blood, and prevent 
the patient's making water, which must be attended with obvious 
inconveniences. This was the case with a patient whose penis I 
amputated. 



SECTION IV. 

Of Warts. 

Another disposition which these parts acquire from the venereal 
poison is, the disposition to form excrescences, or cutaneous tumors, 
called warts. This disposition is strongest, where the chancres were; 
and indeed chancres often heal into warts; but perhaps the parts ac- 
quire this disposition from the venereal matter having been long^ in 
contact with their surfaces; for it often happens after gonorrhoeas, 
where there had been no chancres; and probably it is only in those 
cases where the venereal matter had produced the venereal stimulus 
upon the glans and prepuce, forming there what may be called an in- 
sensible gonorrhoea. 

A wart appears to be an excrescence from the cutis, or a tumor 
forming upon it, by which means it becomes covered with a cuticle, 
which, like all other cuticles, is either strong and hard, or thin and 
soft, just as the cuticle is which covers the parts from whence they 
arise. They are radiated from their basis to the circumference, 
the radii appearing at the surface, pointed or granulated, much 
like granulations that are healthy, except that they are harder, 
and rise above the surface. It would appear that the surface 
on which each is formed, has only the disposition to form one, 
because the surrounding and connecting surface does not go into 
the like substance; thus a wart once begun does not increase in its 
basis, but rises higher and higher. They have an increasing power 
within themselves; for after rising above the surface of the skin, on 
which they are not allowed to increase in breadth at the basis, 
they swell out into a round thick substance, which becomes rougher 
and rougher. 

This structure often makes them liable to be hurt by bodies rubbing 
against them; and often from such a cause they bleed very profusely, 
and are very painful. 

These excrescences are considered by many not as simply a con- 
sequence of the venereal poison, but as possessed of its specific dispo- 
sition, and therefore they have recourse to mercury for the cure of 



SECT. IV. OF CHANCRE. 233 

them; and it is asserted, that such treatment often removes them 
Such an effect of mercury I have never seen, although given in such 
a quantity as to cure in the same person recent chancres, and some- 
times a pox. 

As these substances are excrescences from the body, they are not 
to be considered as truly a part of the animal, not being endowed 
with the common or natural animal powers, by which means the cure 
becomes easier. They are so little of the true animal, and so much 
of a disease, that many trifling circumstances make them decay; 
an inflammation in the natural and sound parts round the wart will 
give it a disposition to decay; many stimuli applied to the surface 
will often make them die. Electricity will produce action in them 
which they are not able to support; an inflammation is excited round 
them, and they drop off. 

From this view of them, the knife and escharotics must appear not 
always necessary, although these modes will act more quickly than 
any other in many cases, especially if the neck is small. In such 
formed warts perhaps a pair of scissors is the best instrument; but 
where cutting instruments of any kind are horrible to the patient, a 
silk thread tied round their neck will do very well; but in whichso- 
ever way it is separated, it will be in general necessary to touch the 
base with caustic. 

Escharotics act upon warts in two different ways, namely, by dead- 
ening a part and stimulating the remainder; so that, by the applica- 
tion of escharotic after escharotic, the whole decays tolerably fast; 
and it is seldom necessary to eat them down to the very root, as the 
basis or root often separates and is thrown off. This, however, is 
not always the case; for we find that the root does not ahvays 
separate, and that it will grow again; therefore, in such cases, it 
is necessary to eat down lower than the general surface to remove 
the root. 

Any of the caustics, such as the lapis septicus, as also the me- 
tallic salts, such as the lunar caustic, blue vitriol, &c. have this 
power. The rust of copper and savine leaves mixed are one of the 
best stimulants. 

After they have been, to appearance, sufficiently destroyed, they 
often rise anew, not from any part being left, but from the sur- 
face of the cutis having the same disposition as before. This re- 
quires a repetition of the same practice, so as to take off that surface 
oi' the cutis. 



G S 



234 OF CHANCRE- CHAP. V. 

SECTION V. 

Of Excoriations of the Glans and Prepuce. 

It very often happens that the surface of the glans and inside of 
the prepuce excoriate, becoming extremely tender, and then a matter 
oozes out. The prepuce in such cases often becomes a little thickened, 
and sometimes contracts in its orifice, both which circumstances 
render the inversion of it difficult and painful. Whether this com- 
plaint ever arises from a venereal cause is not certain, as it often 
takes place where there never has been any venereal taint. 

This disease is in the cutis; and under such a disposition it has no 
power of forming a good cuticle. It is very similar to a gonorrhoea 
in this part, but is not venereal. 

Drawing the pepuce back, and steeping the parts in a solution of 
lead, often takes off the irritation, and a sound cuticle is formed. 
Spirits diluted often produce the same effect; the unguentum citrinum 
of the Edinburgh Dispensatory, lowered by mixing with it equal 
parts of hogs'-lard, is often of singular service in such cases; but 
there are cases which bid defiance to all our applications, in which 
I have succeeded by desiring the person to leave the glans unco- 
vered, which produced the stimulus of necessity for the formation of 
a natural cuticle. 



<"Hap. r op bubo. 235 



PART V. 



CHAP. I. 



Of Bubo. 



A knowledge of the absorbing system, as it is now established, 
gives us considerable information respecting many of the effects of 
poisons, and illustrates several symptoms of the venereal disease, in 
particular the formation of buboes. Prior to this knowledge, we find 
writers at a loss how to give a true and consistent explanation of many 
of the symptoms of this disease. The discovery of the lymphatics 
being a system of absorbents, has thrown more light on many diseases 
than the discovery of the circulation of the blood; it leads, in many 
cases, directly to the cause of the disease. 

The immediate consequence of the local diseases, gonorrhoea and 
chancre, which is called bubo, as also the remote, or lues venerea, 
arise from the absorption of recent venereal matter from some sur- 
face where it has either been applied or formed. Although this must 
have been allowed, in general, ever since the knowledge of the dis- 
ease and of absorption, yet a true solution of the formation of bubo 
could not be given till we had acquired the knowledge of the lym- 
phatics being the only absorbents. Upon the old opinion of absorp- 
tion being performed by the veins, the lues venerea could have easily 
been accounted for, because it could as readily be produced by the 
absorbing power of the veins, if they had such, as by the lymphatics; 
but the difficulty was to say how the bubo was formed. There they 
seemed to be at a loss to account for this disease, yet they sometime* 
expressed themselves as if they had some idea of it, although at the 
same time they could have no clear notions of what they advanced; 
nor could they "demonstrate what they said from the knowledge of the 
parts and their uses. 

Buboes are by some imputed to the stopping of a gonorrhoea, or, 
as thev expressed it, driving it to the glands of the groin, conforma- 
bly to the idea they had of the cause of the swelling of the testicle: 
but this is not just, for we know of no such power as repulsion; and 
if it was driven there, it could not be by stopping the formation of 
nutter but by increasing the absorption, of which they had no idea. 

When we examine the opinion of authors concerning the tormation 



236 OF BUBO. CHAP - '• 

of bubo, prior to the knowledge of the power of absorption in the 
lymphatics, we shall find them making use of terms which they could 
not possibly understand. For instance, Heister says, " They are of 
two kinds, one venereal, and the other not;" but he does not say, that 
the venereal arises only from impure coition. 

Astruc says, page 326, that some buboes arise immediately from 
impure coition, and these he calls essential; others from suppressed 
gonorrhoea, or a small discharge, or from chancres of the penis, and 
these he calls symptomatic; lastly, that they arise spontaneously, 
without any immediate previous coition, and are a pathognomonic 
sign of a hidden pox. 

In page 327 he shows the impossibility of this last happening from 
what we now call, or understand by a lues venerea; but in page 328 
he explains what he calls a latent lues venerea, which is local affec- 
tion produced, as he supposed, from a lues venerea; but which most 
probably never yet happened: and if ever they had arisen from such 
a cause, even the absorption of their matter could not produce a ve- 
nereal bubo, as will be explained. In short, as he understood not 
the true absorbing system, his ideas are become now unintelligible.* 

We find Cowper, Drake, and Boerhaave, as well as Astruc, speak- 
ing of the vitiated lymph not passing the glands, therefore inflaming 
them; also or the inspissated lymph passing either by the circulation 
of the blood, that is, from the constitution to these glands, (an opi- 
nion held by some to this day,) or by a shorter course, viz. the lym- 
phatic vessels which go to the inguinal glands. They also speak of 
the swelling of the inguinal glands, or venereal buboes, from the con- 
tagion being communicated by the resorbent lymphatics. Drake 
even speaks more pointedly; and if we consider him no further, he 
would almost make us believe, that he kneAV that the lymphatics 
were the absorbents; but as he has no such ideas when treating of 
those vessels expressly, we are not to give him credit for it. His 
words are, " The venereal bubo may very likely take its rise from 
some parts of the contagious matter of claps sucked up by the lym- 
phatics of the penis, and thence imparted to the inguinal glands, where 
they deposit their liquor; and thence it well behoves the surgeon to 
be as early as may be in the opening of such tumors, before by the 
exporting vessels of that class the poison is carried further into the 
blood, which very probably may be the case where such tumor 
ariseth immediately upon the stopping of a gonorrhoea, as does the 
hernia humoralis; but when 'the same appears some months after 
that was removed, we are to suppose, as in cases of other poisons 
laying hold of the blood, by the strength of nature it is thrown forth, 
either by means of the lymphatics of the blood-vessels themselves, if 
notspewed out of the nervous tubes, as Wharton surmised, and de- 
posited in those emunctories." 

* The above extracts are from the English edition, published in the year 1754 
;>age 326. 



chap. i. 0P BUE0> 237 

Here he compares it to the formation of a hernia humoralis, which 
plainly shows that he understood neither of them. 

Even so late as the year 1748, we do not find any new ideas on 
this subject. Preke says, " By sealing up the mouths of the glands 
of the urethra, the poison is thence by the ducts leading to the in- 
guinal glands conveyed to them." 

In the year 1 754, eight years after Dr. Hunter having publicly 
taught his opinion of the lymphatics being a system of absorbents, 
we find a treatise on this disease by Mr. Gataker, where as little new 
is advanced on this subject as in any of the former. 

When we come so low down as the year 1770, in an abridgment 
of Astruc, by Dr. Chapman, (second edition,) in which he introduces 
his own knowledge and ideas, we find the absorbing power of the 
lymphatics brought in as a cause of the formation of buboes; by this 
time the knowledge of the lymphatics being the system of absorbents 
was in this country generally diffused. 

The doctrine of absorption being now perfectly understood, wr 
have only to explain the different modes in which it may take place. 

The venereal matter is taken up by the absorbents of the part in 
which it is placed; and although the absorption of the matter and 
the effects after absorption are the same, whether from the matter 
of the gonorrhoea or chancre, yet I shall divide the absorption into 
three kinds, according to the three different surfaces from which the 
matter may be absorbed, beginning with the least frequent. 

The first and most simple is, where the matter effher of gonorrhoea 
or chancre has only been applied to some sound surface, without 
having produced any local effect on the part, but has been absorbed 
immediately upon its application. Instances of this I have seen 
in men, and such are perhaps the only instances that can be depend- 
ed upon ; for it is uncertain, in many cases, whether a woman has a 
gonorrhoea or not. I think however I may venture to affirm that I 
have seen it in women, or at least, there was every reason to believe, 
that they had neither chancre nor gonorrhoea preceding, as there 
was no local appearance of it, nor did they communicate it to others 
who had connexion with them. 

It must be allowed that this mode of absorption is very rare; and 
if we were to examine the parts very carefully, or enquire of the pa- 
tients very strictly, probably a small chancre might be discovered to 
have been the cause, which I have more than once seen: for when 
we consider how rarely it happens from gonorrhoea, in which the. 
mode of absorption is similar, we can hardly suppose it probable that 
it should here arise from simple contract, the time of the application 
of the venereal matter being commonly so very short. We might in- 
deed suppose the frequency to make up for the length of time, which 
we can hardly allow; for the same frequency should give the chance 
of producing it locally. Therefore very particular attention should 
be paid to all the circumstances attending such cases. 



238 «F BUBO. CHAP. 1 

There is however no great reason why it should not happen, and 
the possibility of it lessens the faith that is to be put in the supposi- 
tion, that the disease may be years in the constitution before it ap- 
pears; for whenever it does appear in a lues venerea, its date is al- 
ways carried back to the last local affection, whether gonorrhoea or 
chancre, and the latter connexions are never regarded. 

The second mode of absorption of this matter is more frequent than 
the former, and it is when the matter applied has produced a gonor- 
rhoea; and it may happen while the complaint is going on, either un- 
der a cure or not. Some of the matter secreted by the inflamed 
surfaces having been absorbed and carried into the circulation, pro- 
duces the same complaints as in the former case, by which means 
the person gives himself the lues venerea. 

The third mode of the absorption of the matter from an ulcer, 
which either may be a chancre or a bubo. This mode is by much 
the more frequent; which, with many other proofs, would show that 
a sore or ulcer is the surface most favourable for absorption. Whe- 
ther ulcers in every part of the body have an equal power of absorp- 
tion I have not been able to determine; but I suspect, that an ulcer 
on the glans is not so good a surface for absorption as one on the pre- 
puce, although I have seen both buboes and the lues venerea arise 
from the former; but not so often as from ;he latter. 

To these three methods may be added a fourth, absorption from 
a wound, which I have already remarked is, perhaps, not so frequent 
as any of the former. 

As the venereal poison has the power of contaminating whatever 
part of the body it comes in contact with, it contaminates the absorb- 
ent system, producing in it local venereal complaints. It is hardly 
necessary to observe, that what is now commonly understood by a 
bubo is, a swelling taken place in the absorbent system, especially in 
the glands, arising from the absorption of some poisons or other irri- 
tating matter; and when such swellings take place in the groin, they 
are called buboes, whether from the absorption or not, but are most 
commonly supposed to be venereal, even although there has been no 
visible preceding cause. This has been so much the case, that all 
swellings in this part have been suspected to be of this nature; fe- 
moral ruptures and aneurisms of the femoral artery have been mis- 
taken for venereal buboes. 

I shall call every abscess in the absorbing system, whether in the 
vessels or the glands, arising in consequence of the absorption of ve- 
nereal matter, a bubo. 

This matter, when absorbed from either of the four different sur- 
faces, which arc, common surfaces, wounds, inflamed surfaces, and 
ulcers, is carried along the absorbent vessels to the common circula- 
tion; and in its passage often produces the specific inflammation in 
these vessels; the consequence of which is, the formation of buboes, 
which are venereal abscesses, exactly similar in their nature and ef- 
fects to a chancre; the only difference being in size. As the absorb- 



^"AP. I. OF BUBO. 239 

ents with the glands are immediately irritated by the same specific 
matter which has undergone no change in its passage, the consequent 
inflammation must, therefore, have the same specific quality, and 
the matter secreted in them be venereal.* 

As this system of vessels may be divided into two classes, the ves- 
sels themselves, and their ramifications and convolutions, called the 
lymphatic glands, I shall follow the same division in treating of their 
inflammations. 

Inflammation of the vessels is not nearly so frequent as that of the 
glands. In men, such inflammations, in consequence of chancres 
upon the glans or prepuce, generally appear like a chord leading 
along the back of the penis from the chancres. Sometimes they 
arise from the thickening of the prepuce in gonorrhoeas, that part, 
in such cases, being generally in a state of excoriation, as was 
described when I treated of that form of the disease. These chords 
often terminate insensibly on the penis, near its root, or near the 
pubes; at other times they extend further, passing to a lymphatic 
gland in the groin: this chord can be easily pinched up between the 
ringer and thumb, and it often gives a thickness to the prepuce, 
making it so stiff at this part as to make the inversion of it difficult, 
if not impossible, producing a kind of phymosis. 

I think I have observed this appearance to arise as frequently from 
the gonorrhoea, when attended with the before-mentioned inflamma- 
tion and tumefaction of the prepuce, as from chancres; which, if mj 
observation is just, is not easily accounted for. I have observed thai 
absorption is more common to ulcers than inflamed surfaces; or ar 
least the formation of a bubo in the gland, and its effects in the con- 
stitution, are more common from an ulcer; but it may be remarked, 
that the inside of the prepuce, from whence this chord appears to arise, 
is in an excoriated state. It is possible that this effect may arise 
from the lymphatics sympathizing with the inflammation of the ure- 
thra; but I believe the affection is truly venereal; or it is possible 
that even the absorption of the coagulable lymph, which was produc- 
ed from the venereal inflammation, and which is the cause of the 
tumefaction, may have the power of contamination, as appears to be 
the case in the cancer. 

The thickening, or the formation of this hard chord, probably 
arises from the thickening of the coats of the absorbents, joined with 
the extravasation of coagulable lymph, thrown in upon its inner sur- 
face, as in inflamed veins. 

This chord often inflames so much as to suppurate, and sometimes 
in more places than one, forming one, two, or three buboes, or small 

* I do not know how far this reasoning will hold good in all cases of poisons ; 
for I very much suspect that the bubo that is sometimes formed, in consequence 
of inoculation of the small-pox, docs not produce variolous matter. The na- 
tural poisons, in producing buboes, certainly do not forma poison similar to 
themselves. 



240 OF BUBO. CHAP. I. 

abscesses, in the body of the penis. When this is going on, we find 
in some parts of thischord a circumscribed hardness; then suppura- 
tion takes place in the centre, the skin begins to inflame, the matter 
comes nearer to it, and the abscess opens like any other abscess. 

I have seen a chain of these buboes, or little abscesses, along the 
upper part of the penis through its whole length. 

This may be supposed to be exactly similar to the inflammation 
and suppuration of a vein after being wounded and exposed. 

Inflammation of the glands is much more frequent than the former, 
and arises from the venereal matter being carried on to the lymphatic 
glands; the structure of which appears to be no more than the rami- 
fications and re-union of the absorbent vessels, by which means they 
form these bodies. 

From this structure we may reasonably suppose that the fluid ab- 
sorbed is in some measure detained in these bodies, and thereby has 
a greater opportunity of communicating the disease to them than to 
the distinct vessels, where its course is perhaps more rapid; which 
may account for the glands being more frequently contaminated* 

Swellings of these glands are common to other diseases, and should 
be carefully distinguished from those that arise from the venereal 
poison. The first inquiry should be into the cause, to see if there is 
any venereal complaint at some greater distance from the heart, as 
chancres on the penis, or any preceding disease on the penis; to learn 
if mercurial ointment has been at all applied to the legs and thighs 
of that side; for mercury applied to those parts for the cure of a chan- 
cre, will sometimes tumefy the glands, which has been supposed to 
be venereal. We should further observe if there be no preceding 
disease in the constitution, such as a cold, fever, &c. the progress of 
the swelling with regard to quickness is also to be attended to, as 
also to distinguish it from a rupture, lumbar abscess, or aneurism of 
the crural artery. 

Perhaps these bodies are more irritable, or more susceptible of 
stimuli, than the vessels. They are certainly more susceptible of 
sympathy; however we arc not yet sufficiently acquainted with the use 
of these glands to be able to acccimt satisfactorily for this difference. 

It would appear, in some cases, that it is some time after the ab- 
sorption of the venereal matter before it produces its effects upon the 
glands; in some it has been six days at least. This could only be 
known by the chancres being healed six days before the bubo began 
to appear; and in such cases it is more than probable that the matter 
had been absorbed a much longer time before; for the last matter of a 
chancre most probably is not venereal; and indeed it is natural to 
suppose that the poison may be as long before it produces an action on 
the parts, when applied in this way,, as it is either in the urethra, or in 
forming a chancre; which I have shown to be sometimes six or seven 
weeks. 

The glands nearest to the seat of absorption are in general the only 



CHAP. I. OF BUBO 241 

ones that arc attacked, as those in the groin, when the matter has been 
taken up from the penis in men. In the groin, between the labia and 
thigh, and the round ligaments, when absorbed from the vulva, in wo- 
men. I think there is commonly but one gland at a time that is af- 
fected by the absorption of venereal matter, which, if so, becomes in 
some sort a distinguishing mark between venereal buboes and other 
diseases of these bodies. We never find the lymphatic vessels, or 
glands, that are second in order, affected; as those along the iliac 
vessels, or back; and I have also seen, when the disease has been 
contracted by a sore, or cut upon the finger, the bubo come on a lit- 
tle above the bend of the arm, upon the inside of the biceps muscle: 
and in such where the bubo has come in that part none has formed 
in the arm-pit, which is the most common place for the glands to be 
affected by absorption. 

But this is not .universal, although common; for I was informed 
by a gentleman who contracted the disease in the before-mentioned 
way, that he had buboes both on the inside of the biceps muscle and 
in "the arm-pit. Another case of this kind I have heard of since: 
why it is not more common is perhaps not easily explained. 

It might be supposed that the matter was weakened, or much di- 
luted by the absorptions from other parts by the time it gets through 
these nearest ramifications, and therefore has not power to contami- 
nate those which are beyond them; but it is most probable that there 
are other reasons for this. I once suspected that the nature of the 
poison was altered in these glands as it passed through them, which 
was the reason why it did not contaminate the second or third series 
of glands; and also why it did not affect the constitution in the same 
way as it did the parts to which it was first applied; but this expla- 
nation will not account for the next order of glands to suppurating 
buboes not being affected by the absorption of venereal matter. It 
appears to me, that the internal situation of the other glands prevents 
the venereal irritation from taking place in them; and this opinion 
is strengthened, by observing when one of these external glands sup- 
purates and forms a bubo, which is to be considered as a large ve- 
nereal sore or chancre, that the absorption from it, which must be 
great, does not contaminate the lymphatics or glands next in order, 
by the venereal matter going directly through them. 

If this be true, then the skin would seem to be the cause of the 
susceptibility of the absorbents to receive the irritation. Whether 
the skin has the power inherent in itself, or acquires it from some 
other circumstance, as air, cold, or sense of touch, is not easily as- 
certained; but whichever it be it shows, that the venereal matter of 
itself is not capable of irritating, and that it requires a second prmci- 
©le to complete its full effect; that is, a combination of the nature of 
the noison and the influence of the skin, and that influence must be by 
sympathy and therefore weaker than if acting in the same part, that 
is the skin itself; which perhaps is the reason why the venereal 

h h 



242 OF BUBO. CHAP. t. 

matter does not always affect those vessels and glands, while it al- 
Wavs does the skin, if inserted into it. 

The situation of buboes arising from the venereal disease in the 
penis are, m men, in the absorbent glands of the groin: if a gonor- 
rhoea is the cause of a bubo, one groin is not exempted more than the 
other; both may be affected. But if a bubo arises in consequence of 
a chancre, then the groin may be generally determined by the seat 
of the chancre; for if the chancre is on one side of the penis, then the 
bubo will commonly be on that side; however, this is not universal- 
ly the case, for I have known instances, although but few, where a 
chancre on one side of the prepuce, or penis, has been the cause of 
a bubo on the opposite side, which, if arising from that chancre, is a 
proof that the absorbents either anastomose, or decussate each other. 
If the chancre be on the fraenum, or on the middle of the penis, be- 
tween the two sides, then it is uncertain which side will be affected. 

The situation of the glands of the groin is not always the same, 
and therefore the course of the absorbent vessels will vary accord- 
ingly. I have seen a venereal bubo, which arose from a chancre on 
the penis, a considerable way down the thigh; on the contrary, I 
have seen it often as high as the lower part of the belly, before Pou- 
part's ligament, and sometimes near the pubes, all of which three 
situations may lead to some variations in the method of cure, there- 
fore it may be proper to attend to them. 

As the disease most commonly arises from copulation, the situa- 
tions of buboes are generally in the groin; but as no part of the body, 
under certain circumstances, is exempt from this disease, we find the 
nearest external glands between the part of absorption and the heart, 
every where in the body share the same fate with those of the groin, 
especially if external. 



The introductory part of this chapter may be considered as an af- 
fectionate tribute of Mr. Hunter to his deceased brother. At this 
time the absorbent properties of the lymphatics are so generally un- 
derstood, that some of the remarks may seem superfluous. It must, 
however, have been interesting to our author to trace the erroneous 
theories formed by those who wrote previously to this grand disco- 
very, and even by Gatteker, who might have been better informed. 

The next consideration is, the different modes in which absorption 
may take place. In the first of these, I cannot help suspecting less 
decision than Mr. Hunter usually assumes where he is satisfied of a 
fact. He says, indeed, that he has seen buboes produced in men 
without any local affection (either chancre or gonorrhoea) on the parts 
to which the virulent matter has been applied. He afterwards adds, 
" this mode of absorption, it must be allowed, is very rare, and pro- 
bably a small chancre might be discovered to be the cause which I 
have seen." There is something iu all this which looks like indeci- 



CHAP. H\ OF BUBO. 



243 



sion. It will presently appear, too, that the author admits the diffi- 
culty, perhaps we may say the impossibility, of always distinguish- 
ing "the venereal bubo from some other affections of the inguinal 
glands. If I were allowed to draw an inference from the whole, 
and from conversations with Mr. Hunter, I should say, though he had 
seen such buboes, which, by their progress and appearance, might 
be suspected to be venereal, yet he had never perfectly ascertained 
the fact. This subject will be reconsidered when we arrive at " se- 
condary symptoms or lues venereal." 



CHAP. II. 

Of Buboes in Women. 

The same diseases in the absorbents in consequence of the ab- 
sorption of the venereal matter, take place in this sex as well as in 
men I never saw but one case where the absorbent vessels were 
diseased; but this is nearly in the same proportion as in men, when 
I consider the proportion the number of the one sex bears to that ot 
the other who apply to me for a cure of the venereal disease in any 
form The case was a gonorrhoea with violent itching and soreness 
when the patient sat or walked; but she had very little pain in mak- 
ing W ater When I examined the parts, I could see no difference 
between them and sound parts, excepting that the left labium was 
swelled, or fuller than the other, and a hard chord passed from the 
centre of that labium upwards to the os pubis, and passed on to the 
groin of the same side, and was lost in a gland as high as Poupart s 
Lament. It was not to be felt but by pressing the parts with some 
force, and it gafe considerable pain upon pressure. 

The swelling of the labium appeared to be somewhat similar to 
the swelling of the prepuce in similar cases in men, so that they 
would appear to arise from the same cause. • 

One would naturally suppose that what has been said of his com- 
plaint in the lymphatic glands in men would be wholly applicable to 
women ; and also that nothing peculiar to women could take place ; but 
the seat of absorption is more extensive in this sex, and the course of 
some of the absorbents is also different; from whence there are three 
Stions of buboes in women, two of which are totally different 
from those in men, and these I suspect to be in the absorbents. 

The third situation of buboes in this sex is similar to that m men; 
a n,l tWefore thev may be divided into three, as in men. 

U hon b'boerarise^ women where there is no chancre, it is more 



244 OP BUBO. CHAP. Ill, 

difficult to know whether they are venereal or not than in men; for 
when they arise in men without any local complaint, it is known that 
no such complaint exists, and therefore the bubo cannot be venereal, 
excepting by immediate absorption; but in women it is often difficult 
to know whether there be any infection present or not; and there- 
fore, in order to ascertain the nature of the bubo, attention must be 
paid io its manner of coming on, progress, and other circum- 
stances. 

When chancres are situated forwards, near to the meatus urina- 
rius, nymphae, clitoris, labia, or mons veneris, then we find that the 
matter absorbed is carried along one or both of the round ligaments, 
and the buboes are formed in those ligaments just before they enter 
the abdomen, without, I believe, ever going further. These buboes 
I suspect not to be glandular, but inflamed absorbents; and if so, it 
strengthens the idea that it is only an external part that can be af- 
fected in this way. 

When the chancres are situated far back, near the perinaeum, or 
in it, the matter absorbed is carried forwards along the angle be- 
tween the labium and the thigh to the glands in the groin, and often 
in this course there are formed small buboes in the absorbents, simi- 
lar to those on the penis in men; and when the effects of the poison 
do not rest here, it often produces a bubo in the groin as in men. 



CHAP. III. 



Of the Inflammation of Buboes, and the Marks that distinguish them 
from other Swellings of the Glands. 

The bubo commonly begins with a sense of pain, which leads the 
patient to examine the part, where a small hard tumor is to be felt* 
This increases like every other inflammation that has a tendency to 
suppuration; and, if not prevented, goes on to suppuration and ulcer- 
ation, the matter coming fast to the skin. 

But we find cases where they are slow in their progress, which I 
suspect either arises from the inflammatory process being kept back 
by mercury, or other means; or being retarded by a scrofulous ten- 

* It must be remarked here, that, whenever a person lias either a p-onorrhcea 
or a chancre, lie becomes apprehensive of a bubo ; and as there are m the go- 
norrhoea, and sometimes in the chancre, sympathetic sensations in or near the 
groin, they are suspected by the patient to be beginning buboes, and the hand 
is immediately applied to that part; and if he feels one of the glands, although 
not in the least increased, the suspicions are confirmed from a belief tint he has 
no such parts naturally. 



f iHAP. Ill OP BUBO. 245 

dency, such a disposition in the parts not so readily admitting the 
true venereal action. 

At first the inflammation is confined to the gland, which is move- 
able in the cellular membrane; but as it increases in size, or as the 
inflammation, and more especially the suppuration, advances, which 
in all cases produce rather a common than a specific effect, the spe- 
cific distance is exceeded; the surrounding cellular membrane be- 
comes more inflamed; and the tumor is more diffused. Some bu- 
boes become erysipelatous, by which means they are rendered more 
diffuse and oedematous, and do not readily suppurate; a circumstance 
often attending the erysipelatous inflammation. 

To ascertain what a disease is, is the first step in the cure; and 
when two or more causes produce similar effects, great attention is 
necessary to distinguish one effect from another, so as to come at the 
true cause of each. 

The glands of the groin, from their situation, are liable to suspi- 
cion; for, besides being subject to the common diseases, they become 
exposed to others, by allowing whatever is absorbed to pass through 
them; and as the route of the venereal poison to the constitution is 
principally through them, and being oftener ill from this cause than 
any other, they often are suspected of this disease without founda- 
tion. 

To distinguish, with certainty, the true venereal bubo from swell- 
ings of those glands arising from other causes may be very difficult. 
We must, however, examine all circumstances, to ascertain in what 
the bubo differs from the common diseases of those glands, whether 
in the groin or elsewhere; in which examination the apparent causes 
are not to be neglected. I have already given the character of the 
venereal bubo in general terms; but I shall now be more particular, 
as the two are to be contrasted. 

The true venereal bubo, in consequence of a chancre, is most 
commonly confined to one gland. It keeps nearly its specific dis- 
tance till suppuration has taken place, and then becomes more dif- 
fused * It is rapid in its progress from inflammation to suppuration 
and ulceration. The suppuration is commonly large for the size of 
the gland, and but one abscess. The pain is very acute. The co- 
lour of the skin, where the inflammation attacks, is of a florid red. 

It may be observed, that the buboes, in consequence of the first 
mode of absorption, viz. where no local disease has been produced, 
will always be attended with a greater uncertainty of the nature of 
the disease than those attended or preceded by a disease in the penis; 
because a simple inflammation and suppuration of these glands are 
not sufficient to mark it to be venereal; but as we always have this 

* It may be observed here, that the glands and surrounding parts being dis- 
similar, inflammation does not so readily become diffused as when it takes place 
in a common part 



24G OF BUBO. CHAP. III. 

disease in view when the glands of the groin are the seat of the dis- 
ease, the patient runs but little risk of not being cured, if it should 
be venereal; but I am afraid that patients have often undergone a 
mercurial course when there has been no occasion for it. 

It will perhaps be difficult to find out the specific difference in the 
diseases themselves; but I think that such buboes as arise without 
any visible cause are of two kinds, one similar to those arising from 
chancres or gonorrhoea; that is, inflaming and suppurating briskly. 
These I have always suspected to be venereal; for although there is 
no proof of their being so, yet from these circumstances there is a 
strong presumption that they are. 

The second are generally preceded and attended with slight 
fever, or the common symptoms of a cold, and they are generally in- 
dolent and slow in their progress. If they are more quick than ordi- 
nary, they become more diffused than the .venereal, and may not be 
confined to one gland. When very slow they give but little sensa- 
tion; but when more quick the sensation is more acute, though not so 
sharp, as in those that are venereal; and most commonly they do not 
suppurate, but often become stationary. When they do suppurate, it 
is slowly, and often in more glands than one, the inflammation being 
more diffused, and commonly small in proportion to the swelling. 
The matter comes slowly to the skin, not attended with much pain, 
and the colour is different from that of the other, being more of the 
purple. Sometimes the suppurations are very considerable, but not 
painful. 

Now let us see what other causes there are for the swelling of 
these glands besides venereal infection, to which I have ascribed one 
of the modes of swelling; for there must be other causes to account for 
the other modes of it. 

The first thing to be attended to is, whether or not there are any 
venereal complaints; and if not, this becomes a strong presumptive 
proof that they may not be venereal, but proceed from some unknown 
cause. If the swelling is only in one gland, very slow in its pro- 
gress, and gives but little or no pain, it is probably merely scrofu- 
lous; but if the swelling is considerable, diffused, and attended with 
some inflammation and pain, then it is most probable that there is a 
constitutional action consisting in slight fever, the symptoms of which 
are, lassitude, loss of appetite, want of sleep, small quick pulse, and 
an appearance of approaching hectic. Such swellings are slow in 
their cure, and do not seem to be affected by mercury, even when 
very early applied. 

A gentleman had all the symptoms of a slight fever; the pulse a lit- 
tle quick and hard, loss of appetite, and of course loss of flesh; a list- 
lessness, and a sallow look. While he was in this state, a swelling 
took place in the glands of one of the groins. He immediately sent 
for me, because he imagined it to be venereal. From the history of 
the case, I gave it as my firm opinion it was not; in this he had 



«UP. IH. OF BUBO. 247 

not much faith. The swellings were not very painful; and after hav- 
ing acquired a considerable size, they became stationary. To please 
him, I gave him a box of mercurial ointment, to be rubbed on the 
leg and thigh only of the side affected, that it might have a sufficient 
local effect, and as little go into the constitution as possible; but it did 
not appear to be of any service to the swellings in the groin, they 
remaining stationary, and almost without pain. His friends became 
uneasy, and sent their surgeons to him, who, without knowing he was 
my patient, and of course without knowing my opinion, imagined that, 
the disease was venereal, and talked of giving mercury. With re- 
spect to the cure, I thought he should go to the sea and bathe. 

Allowing the chance of the disease being venereal or not venereal 
to be equal, I reasoned upon that ground. His present want of health 
could not be supposed to arise from any venereal cause, as it was 
prior to the swelling in the groin, and therefore, though the swelling 
might be venereal, he was not at present in a condition to take mer- 
cury, as a sufficient quantity of that medicine for the cure might kill 
him; and if it should not be venereal, that still a greater quantity of 
mercury must be given than what was necessary if it were venereal; 
because its not giving way readily would naturally make the surgeon 
push the mercury further; and, besides this disagreeable circum- 
stance, the disease in the groin might be rendered more difficult of 
cure. But by going to the sea, his constitution would be restored; 
and if the disease in the groin proved to be venereal, he would be in 
a proper condition to go through a mercurial course, and by that 
means get rid of both diseases by the two methods. But if I 
should be right in my opinion, that there was nothing venereal 
in the case, then he would probably get well by the sea-bathing 
alone. 

These arguments had the desired effect; he went directly to the 
sea, and began to recover almost immediately. About a fortnight 
after, a small suppuration took place in one of the glands. I direct- 
ed that a poultice should be made with sea-water, and applied; and, 
in case of the breaking of the abscess, that it should not be further 
opened, but poulticed till healed. In six weeks he came back per- 
fectly recovered in every respect. 

The above-mentioned appearance, with the constitutional affec- 
tions, I have seen take place when there were chancres; and I have 
been puzzled to determine whether it was sympathetic, from a de- 
rangement of the constitution, or from the absorption of matter. 

I have long suspected a mixed case; and I am now certain that such 
exists. I have seen cases, where the venereal matter, like a cold or 
fever, has only irritated the glands to disease, producing in them 
scrofula, to which they were predisposed. 

In such cases the swellings commonly arise slowly, give but little 
pain and seem to be rather hastened in their progress if mercury is 
given to destroy the venereal disposition. Some come to suppuration 



248 OF BtBO. ^HAP. IV. 

while under this resolving course; and others, which probably had a 
venereal taint at first, become so indolent that mercury has no effect 
upon them, and in the end get well either of themselves or by other 
means; which, I imagine, may have induced some to think that 
buboes are never venereal. Such cases require great attention, 
that we may be able to determine them properly; and, I believe, this 
requires in many cases so nice a judgment, that we shall be often lia- 
ble to mistakes. 

Buboes are undoubtedly local complaints, as has been ex- 
plained. 

How far the lymphatic glands are to be considered as guards 
against the further progress of this or any other disease caught by 
absorption, is not easily determined. We must however allow that 
they cannot prevent the poison from entering the constitution, in 
cases where it produces buboes; for whenever it affects these gland? 
in its course, it produces the same disease in them which is capable 
of furnishing the constitution with an increased quantity of the same 
kind of poison. 



CHAP. IV. 

General Reflections on the Cure of Buboes. 

From what has been offered on the history of buboes, it will be 
needless here to enter into a discussion of the opinion of their being 
a deposit from the constitution, and of the conclusion drawn from this 
opinion, that they ought not to be dispersed; for, according to this 
theory, to disperse them would be to throw the venereal matter upon 
the constitution. But if this were really the case, then there would 
be no occasion for the use of mercury, provided the bubo be allowed 
to proceed, as it would prove its own cure ; but even those who were 
of this opinion were not satisfied with the cure which they supposed 
Nature had pointed out, but gave mercury, and in very large quanti- 
ties. From the same history of a bubo I have also endeavoured to 
show that there are several buboes which are not in the least vene- 
real, but scrofulous; and that there are also buboes which appear to 
be only in part venereal; or perhaps only a gland disposed to scrofula 
brought into action by the venereal irritation, similar to what happens 
often from the matter of the small-pox in inoculation. Therefore, 
prior to the speaking of the method of cure, the true venereal bubo 
is to be distinguished from the others, if possible. When it is well 
ascertained to be venereal, resolution is certainly to be attempted, if 



CHAP. IV. OF BUBO. 249 

the bubo be in a state of inflammation only. The propriety of the 
attempt depends upon the progress which the disease has made. If 
it be very large, and suppuration appears to be near at hand, it is 
probable that resolution cannot be effected; and if suppuration has 
taken place, I should very much doubt the probability of success, and 
an attempt might now possibly only retard the suppuration, and pro- 
tract the cure. 

The resolution of these inflammations depends principally upon 
mercury, and almost absolutely upon the quantity that can be made 
to pass through them; and tbe cure of them, if allowed to come to 
suppuration, depends upon the same circumstances. The quantity 
of mercury, that can be made to pass through a bubo, depends prin- 
cipally upon the quantity of external surface for absorption beyond 
the bubo. 

Mercury is to be applied in the most advantageous manner, that 
is, to those surfaces by an absorption, from which it may pass through 
the diseased gland: for the disease there being destroyed, the consti- 
tution has less chance of being contaminated. The powers of mer- 
cury may often be increased from the manner in which it is applied. 
In the cure of buboes, it should always be made to pass into the con- 
stitution by the same way through which the habit received the 
poison; and therefore, to effect this, it must be applied to the 
mouths of those lymphatics, which pass through the diseased part, 
and which will always be placed on a surface beyond the disease. 

But the situation of many buboes is such as not to have much 
surface beyond them, and thereby not to allow of a sufficient quan- 
tity of mercury being taken in in this way; as for instance, those 
buboes on the body of the penis arising from chancres on the glans or 
prepuce. 

These two surfaces are not sufficient to take in the necessary quan- 
tity to cure those buboes in its passage through them; therefore, 
whenever the first symptoms of a bubo appear, its situation is well 
to be considered, with a view to determine if there be a sufficient 
surface to effect a cure, without our having recourse to other means. 
It is first to be observed, whether the absorbent vessels, on the body 
of the penis, are affected, or the glands in the groin. If the disease 
be in the groin, it must be observed in which of the three situations 
of the bubo, before taken notice of, it is; whether on the upper part 
of the thigh and groin, on the lower part of the belly before Poupart's 
ligament, & or near to the pubes. If they are on the body of the penis, 
this shows that the absorbents, leading directly from the surface of 
absorption, are themselves diseased. If in the groin, and on the upper 
part of the thigh, or perhaps a little lower down than what is com- 
monly called the groin, then we may suppose it is in the glands com- 
mon to the penis and thigh. If high up, or on the lower part of the 
belly before Poupart's ligament, then it is to be supposed that those 
absorbents that arise from about the groin, lower part of the belly, 

i i 



250 OF BUBO. CHAP. IV. 

and pubes, pass through the bubo; and if far forwards, then it is 
most probable that only the absorbents of the penis and skin about 
the pubes pass that way. The knowledge of these situations is very 
necessary for the application of mercury for the cure by resolution, 
and for the cure after suppuration has taken place. 

The propriety of this practice must appear at once, when we con- 
sider that the medicine cannot pass to the common circulation with- 
out going through the diseased parts; and it must promote the cure 
in its passage through them; while at the same time it prevents the 
matter, which has already passed, and is still continuing to pass, into 
the constitution from acting there, so that the bubo is cured and the 
constitution preserved. 

But this practice alone is not always sufficient; there are -many 
cases in which mercury by itself cannot cure. Mercury can only 
cure the specific disposition of the inflammation; and we know that 
this disease is often attended with other kinds of inflammation be- 
sides the venereal. 

Sometimes the common inflammation is carried to a great height, 
at other times the inflammation is erysipelatous, and, I suspect, often 
scrofulous. We must, therefore, have recourse to other methods. 

Where the inflammation rises very high, bleeding, purging, and 
fomenting, are generally recommended. These will certainly lessen 
the active power of the vessels, and render the inflammation more 
languid; but they can never lessen the specific effects of this poison, 
which were the first cause, and are still in some degree the support 
of the inflammation. Their effects are only secondary; and if they 
reduce the inflammation within the bounds of the specific, it is all 
the service they can perform. If the inflammation be of the erysi- 
pelatous kind, perhaps bark is the best medicine that can be given; 
or if it be suspected to be scrofulous, hemlock, and poultices made 
with sea-water, may be of service. 

Vomits have been of service in resolving buboes, even after matter 
has been formed in them, and after they have been nearly ready to 
burst; this acts upon the principle of one irritation destroying ano- 
ther; and sickness and the act of vomiting perhaps give a disposition 
for absorption. A remarkable instance of this kind happened in an 
officer, who had a bubo, at Lisbon. It came to fair suppuration, 
and was almost ready to burst. The skin was thin and inflamed, 
and a plain fluctuation felt. I intended to open it; but as he was 
going on board a ship for England on the day following, I thought it 
better to defer it. When he went on board, he set sail immediate- 
ly; and the wind blew so very hard that nothing could be done for 
some days, all which time he was very sick, and vomited a good 
deal; when the sickness went off, he found the bubo had disappear- 
ed, and it never afterwards appeared. When he came to England, 
he went through a regular course of mercury. 



sect. II. 0P BUB0> 251 

SECTION I. 

Of Resolution of the Inflammation of the Absorbents on the Penis. 

The surface beyond the seat of the disease in this case, that is, all 
that part of the penis before the bubo, is not large enough to take in 
a quantity of mercury sufficient to prevent the effects of absorption, 
and therefore recourse is to be had to other means; yet this applica- 
tion should by no means be neglected, and this surface, small as it 
is, should be constantly covered with mercurial ointment, which 
will assist in the cure of the local disease. It may be disputed whe- 
ther any medicine can pass through diseased lymphatics, so as to 
have any effect upon them, but I judge from experience that it cer- 
tainly can. As this surface is too small, and as it is necessary that 
a larger quantity should be taken in, it becomes proper to give it either 
by the mouth, or by friction on some larger surface; this is neces- 
sary to prevent the lues venerea, as well as to cure the parts them- 
selves. The quantity cannot be determined; that must be left to the 
surgeon, who must be directed by the appearances of the original 
complaint, and the readiness with which the disease gives way. 

The same method is to be followed in women; but as there is a 
larger surface in this sex, more mercury may possibly be absorbed; 
and there should be a constant application of ointment to the inside 
and outside of the labia. 



SECTION II. 

Of the Resolution of Buboes in the Groin. 

The inflammation of the glands is to be treated exactly upon the 
same principle with the other; but we have in general a larger sur- 
face of absorption, so that we can make a greater quantity of mer- 
cury pass through the diseased parts. 

It will be proper to apply the mercury according to the situation 
of the inflamed gland. If the bubo be in the groin, according to our 
first situation, then it is necessary to rub the mercurial ointment upon 
the thigh. This surface will in general absorb as much mercury as 
will be sufficient to resolve the bubo, and to preserve the constitution 
from being contaminated by the poison that may get into it; but if 
resolution does not readily take place, then we may increase the sur- 
face of friction, by rubbing the ointment upon the leg. 



252 OF BUBO. CHAP. IV. 

But if the bubo be en the lower part of the belly, that is, in the 
second situation, then the ointment should be rubbed also upon the 
penis, scrotum, and belly; and the same, if the bubo should be still 
forwards; for probably those glands receive the lymphatics from all 
the surfaces mentioned, as well as from the thigh and leg. 

The length of time for continuing the frictions must be determin- 
ed by circumstances. If the bubo gives way, they must be continued 
till it has entirely subsided, and perhaps longer, on account of the 
cause of it, a chancre, which may not yield so soon as the bubo. If 
it still goes on to suppuration, the frictions may or may not be con- 
tinued; for I do not know for certain if any thing is to be gained by 
their continuance in this state. 

The quantity, here recommended, may affect the mouth; and this 
effect must also be regulated according to circumstances. 



SECTION III. 

Of the Resolution of Buboes in Women. 

When treating on the seat of buboes in women, I observed that 
two situations were peculiar to them, the others similar to those in 
men. 

In the first and second situations, especially the first, the surface of 
absorption, beyond the bubo, is by much too small to be depended 
upon for receiving a sufficient quantity of mercury to produce reso- 
lution; but in the second, that is, between the labia and thigh, the 
mercury may be rubbed in all about the anus and buttock, as all the 
absorbents of those parts probably pass that way; we know at least 
that they do not pass into the pelvis by the anus, but go by the groin. 
Others means of introducing mercury must be recurred to, as is re- 
commended in the case of men; but still it will be proper to rub in on 
these surfaces as much as possible. 

In the situations common to both sexes, we have a larger field; 
yet as they are divisible into three, the same observations hold good, 
and a similar mode of practice is to be followed in women as in 
men. 



SECT. V. OF BUBO. 253 

SECTION IV. 

Of Buboes in other Parts. 

As venereal buboes arise from other modes of application of the 
poison besides coition, they are to be found in different parts of the 
body, but more frequently in the hands. They arise in the arm-pits, 
from wounds in the bands or fingers being contaminated by venereal 
matter, and reduced to a chancre. In such cases it becomes neces- 
sary, that the ointment should be rubbed on the arm and fore-arm; 
but this surface may not be sufficient, therefore we must apply it in 
another way, or to other parts, to produce its effects upon the con- 
stitution. 

I have seen a true venereal chancre, on the middle of the lower 
lip, produce a bubo on each side of the neck under the lower jaw, 
just upon the maxillarv gland. By applying strong mercurial oint- 
ment to the under lip, chin, and swellings, they have been resolved. 



SECTION V. 

Of the Quantity of Mercury necessanj for the Resolution of a Bubo. 

The quantity of mercury necessary for the resolution of a bubo 
must be proportioned to the obstinacy of the bubo; but care must be 
taken to stop short of certain effects upon the constitution. If it be 
in the first situation, and yields readily to the use of half a dram oi 
mercurial ointment, made of equal parts of quicksilver and hogs 
lard, every night, and the mouth does not become sore, or at most 
only tender, then it will be sufficient to pursue this course till the 
gland is reduced to its natural size; and this probably will be a good 
security for the constitution, provided that the chancre, which may 
'have been the cause of the bubo, heals at the same time. It the 
mouth is not affected in six or eight days, and the gland does not rea- 
dily resolve, then two scruples, or a dram, may be applied every 
night' and if there be no amendment, then more must be rubbed in; 
in short, if the reduction is obstinate, the mercury must be pushed as 
far as can be done without a salivation. 

If there be a bubo on each side, then there cannot be so much 
mercury applied locally to each; for the constitution most probably 
could not bear double the quantity which is necessary for the r solu- 
tion of one. But in such cases we must not so much attend to the 



254 OF BUBO. GHAP. IV. 

soreness of the mouth as when there is but one; however, we must 
allow the buboes to go on to suppuration, rather than affect the con- 
stitution too much by the quantity of mercury; and therefore, when 
there are two buboes, they are more likely to suppurate than where 
there is only one. 

In the second and third situation of buboes, if we find that most 
probably a sufficient quantity of mercury does not pass through them 
for their resolution, it may be continued to be thrown in by the leg 
and thigh to act upon the constitution, as has been already observed. 
The quantity admitted in this way must be greater than what would 
be necessary if the whole could be made to pass through the bubo. 
The mouth must be affected, and that in proportion to the state and 
progress of the bubo. 

This method of resolving buboes occurred to me at Belleisle, in 
the year 1761, where I had good opportunities of trying it upon the 
soldiers; and I can say with truth, that only three buboes have sup- 
purated under my care since that time, and two of these were in one 
person, where a small quantity of mercury had considerable effects 
on the constitution, and therefore a sufficient quantity could not be 
sent through the two groins for their resolution; but in both cases the 
suppurations were small in comparison to what they threatened 
to be. 

Many buboes, after every attempt, remain swelled without either 
coming to resolution or suppuration, but rather become hard and 
scirrhous. Such, I apprehend, were either scrofulous at first, or be- 
came so when the venereal disposition was removed. The cure of 
thern should be attempted by hemlock, sea-water poultices, and sea- 
bathing, as will be further taken notice of. 



SECTION VI. 

Of the Treatment of Buboes when they suppurate. 

After every known method has been used, buboes cannot in all 
cases be resolved, but come to suppuration. They then become 
more an object of surgery, and are to be treated in some respects 
like any other abscess. If it be thought proper to open a bubo, it 
should be allowed to go on thinning the parts as much as possible. 
The great advantage arising from this is, that these parts, having be- 
come very thin, lose the disposition to heal, which gives the bottom 
of the abscess a better chance of healing along with the superficial 
parts: by this means, too, a large opening is avoided, and the differ- 



SECT. VI. OF BUBO. * 255 

ent modes made use of for keeping the skin from healing, till the 
bottom is healed, become unnecessary. 

It may admit of dispute, whether the application of mercury should 
be continued or not through the whole suppuration. I should be in- 
clined to continue it, but in a smaller quantity; for although the 
parts cannot set about a cure till opened, yet I do imagine that they 
may be better disposed to it; and I think that I have seen cases 
where suppuration has taken place, although under the above-men- 
tioned practice, that were very large in their inflammation, but very 
small in their suppuration, which I imputed to the patient's having 
taken mercury in the before-mentioned way, both before and while 
suppuration was going on. 

It has been disputed more in this kind of abscess than in others, 
whether it should be opened or allowed to burst of itself; and like- 
wise whether the opening should be made by incision or caustic. 

There appears to be nothing in a venereal abscess different from 
any other, to recommend one practice more than another. The sur- 
geon should in some degree be guided by the patient. Some patients 
are afraid of caustics; others have a horror of cutting instruments; 
but when it is left wholly to the surgeon, and the bubo is but small, 
I suppose, a slit with a lancet will be sufficient; in this way no skin 
will be lost. But when a bubo is very large, in which there is a 
large quantity of loose skin, perhaps the caustic will answer better, 
both on account of its destroying some skin, and because the de- 
struction is attended with less inflammation than what attends inci- 
sion. If done by a caustic, the lapis septicus is the best;* but it is 
not necessary to open every bubo, and perhaps it may be difficult to 
point out those where opening would be of service, or necessary. 

The bubo is to be dressed afterwards according to the nature of 
the disease, which, I have already observed, is often so complicated 
as to baffle all our skill. The constitution at the same time is to be 
attacked with mercury, either by applying it internally or externally; 
if externally, it should be applied to that side, and beyond where the 
bubo is, as I before directed, in treating of the resolution of buboes; 
for it may have some influence on the disease in its passing through 
the part. 

Mercury, in these cases, answers two purposes; it assists the ex- 
ternal applications to cure the buboes, and it prevents the effects of 
the constant absorption of the venereal matter from the sore. 

How far it is necessary to pursue the mercurial course with a view 
lo prevention, it is not possible to determine; but it may be supposed 

* I once opened two buboes in the same person, one immediately after the 
other The first was with the lapis infernalis, which gave him considerable pain; 
and therefore he would have the other opened with a lancet, as the pain would 
only be momentary : but it was great, and the soreness continued long, while 
there was no pain in the other, deadened by the caustic, atterit had done its 
business. 



: ,>5G OF BUBO. CHAP. V. 

that it is necessary to give the same quantity to prevent a disease 
that would cure one that has already taken place It wi be neces- 
sary to continue the course till the bubo is healed, or till it has tor 
some time lost its venereal appearance; but it may be difficult to 
ascertain this last fact; therefore we must have recourse to experi- 
ence, not theory, and continue the course in general till the whole is 
healed; and even longer, especially if the bubo heals very readily; 
for we find in many cases that the constitution shall be still tainted 
after all; however, some restrictions are here necessary; for I have 
already observed, that it often happens, that buboes assume other dis- 
positions besides the venereal, which mercury cannot cure, but will 
even make worse. It is therefore very necessary to ascertain the 
distinction; which will be taken notice of. 



CHAP. V. 



Of some of the Consequences of Buboes. 

I formerly observed, that the venereal disease is capable of 
bringing latent dispositions or susceptibilities into action. This is 
remarkably the case with buboes; and I believe the disposition is 
more of the scrofulous kind than any other. Whether this arises 
from the buboes being formed in lymphatic glands, or not, is pro- 
bably not easily determined. 

It sometimes happens, that these sores, when losing, or entirely de- 
prived of the venereal disposition, form into a sore of another kind, 
and most probably of various kinds. How far it is a disease aris- 
ing from a venereal taint, and the effects of a mercurial course 
jointly, is not certain; but most probably these two have some share 
in forming the disease. If this idea of it were just, it would be- 
come a specific disease, and be reducible to one method of cure; but 
I should suspect that either the constitution or the part hath some, 
if not the principal, share in it; that is, the parts fall into a peculiar 
disease, independent of the constitutional disease, or method of cure; 
for if it arose out of the two first entirely, we might expect to meet 
with it oftener. So far as the constitution or the part has a share in 
forming this disease, it becomes more uncertain what the disease is, 
because it must in some degree partake of the constitution, or nature 
of the part. 

Such diseases make the cure of the venereal affection much more 
uncertain; because, when the sore becomes stationary, or the mer- 
cury begins to disagree, we are ready to suspect that the virus is 



CHAP - v - op bubo. 257 

gone; but this is not always the case; the virus is perhaps only less 
powerful than the new formed disease, and, as it were, lies dormant, 
or ceases to act; and when the other becomes weaker, the venereal 
influence begins to show itself again. 

The proper treatment, in such cases, is to attack the predominant 
disease; but still the difficulty is to find out the disease, and to know 
when it is or is not venereal. The following case explains this dif- 
ficulty very well: — 

A gentleman had a very large venereal bubo, which was opened. 
He took a great deal of mercury for about two months; but, I sus- 
pect, not in sufficient doses, which produced a mercurial habit. The 
bubo had no disposition to heal, and I was consulted. From the ac- 
count he gave me, I suspected that he had then too much of a mer- 
curial habit to receive at this time any further good from that medi- 
cine. I therefore advised him to use a good nourishing diet for near 
a month; afterthat I put him upon a brisk mercurial course by friction; 
and the parts put on a better appearance. This course he continued 
for near two months, and then the sore, although much mended, be- 
gan to be stationary. I did now conceive that the venereal action was 
destroyed, and therefore immediately left off the mercurial course and 
put him upon a milk diet, and sent him into the country. But not 
gaining much ground, he had a strong decoction of the sarsaparilla, 
with mezereon, given him, which, although continued for above a 
month, produced little or no effect. I also gave him the cicuta as 
much as he could bear, with the'bark almost the whole time, with- 
out effect: new sinuses formed, which were opened, and the sore be- 
came extremely irritable, with thickened lips. The dressings were, 
poultices made with the juice of hemlock, sea- water, opium, and a 
gentle solution of lunar caustic; but nothing seemed to affect it. I 
suspected scrofula, and therefore proposed he should bathe in the 
sea; but this then could not be done. These different treatments, 
after mercury had been left off, took up about four months without 
the least benefit. Being doubtful whether there might not be still 
something venereal in the sore, especially as appearances were grow- 
ing worse, and it was now four months since he had taken any mer- 
cury, I was inclined to try it once more, and sent him two portions 
of ointment, half an ounce each, to rub in in two nights. He had 
caught a little cold, and therefore did not rub in the mercury the 
two evenings as ordered; and called upon me the third day, and told 
me he was much better: the sore now became easy; the watery or 
transparent inflammation began to subside; the lips became flatter 
and thinner; and the edges of the sore began to heal. I then desired 
him not to rub in the ointment, but wait a little. In eight or ten days 
the sore had contracted to three quarters of its former size, and had 
all the appearance of a healing sore. 

Quere: What conclusions should be drawn from this case? I 
think the following: that the virus may be gone although the sore 

Kk 



25$ OF BtTBO. CHAP. V. 

may have no disposition to heal: therefore we are not to look upon 
the not healing of a bubo as a sign of the presence of the original 
disease. Secondly, that the sarsaparilla, mezereon, acuta, and the 
bark, will not succeed in all such cases; and thirdly, that some ot 
these diseases are capable of wearing out the unhealthy disposition 
of themselves, and that we should not be too ready to attribute cures 
to our treatment; for if the mercury had been rubbed in, and the 
same effects had still taken place, I should then have certainly pur- 
sued the mercury with vigour, and attributed the cure to it: but I 
should not have rested here: I should have related the case as an 
instance of the disease continuing after repeated courses of mercury, 
and should have contended, that it is necessary in such cases, where 
the mercury appears to lose its power, and even do harm, to wait, 
and season the constitution to strength, and the loss of the mercurial 
habit; and that even four months are sometimes necessary for this 
purpose; after which we must begin again to give mercury. 

A gentleman had a common gonorrhoea, which was severe. I gave 
him an injection of a grain of corrosive sublimate in eight ounces of 
water, with a few mercurial pills. After having continued the in- 
jection for ten or twelve days without any visible benefit, I gave it 
as my opinion that it would be of no service to continue it any longer: 
and therefore desired he would be quiet for a little time. About this 
time a swelling in each groin took place, and supposing them to be 
venereal, I ordered mercurial ointment to be rubbed into both the 
legs and thighs to resolve them if possible. He appeared to be less 
uneasy about the buboes than he was about the gonorrhoea; but I told 
him that the cure of that complaint would be insensibly involved in 
the resolution of the buboes. I spoke too confidently of my power, 
with respect to the resolution of the buboes, for they both suppurat- 
ed; although the suppuration was small in comparison to the mag- 
nitude of the buboes when they first inflamed. The frictions were 
left off. 

While we were attempting to resolve the buboes, he got well of 
the gonorrhoea. The skin covering the buboes became thin; they 
utre both opened, one with a caustic, the other with a lancet; he 
then was ordered to rub in mercury again on the thighs and legs for 
their cure. They began soon to look well, and to close fast; but 
when half healed they became stationary. I suspected that a new 
disease was forming. On continuing the frictions a little longer they 
began to inflame and swell anew, and a suppuration took place about 
half an inch above each of the first suppurations, which broke into the 
first. I left off the mercury immediately upon their inflaming, and 
said that now a new disease had formed. I ordered poultices made 
with sea-water to be applied, and also a decoction of sarsaparilla to be 
taken; but this appeared not to be sufficient for the cure of this new 
disease. I then ordered him to go into the tepid sea-bath every even- 
ing, the heat of the water to be about ninety degrees. By the time 



chap. V. OP BUBO. 259 

lie had been in the bath four times, the inflammation and swelling 
had much abated, and the first sores, or original buboes, were begin- 
ning to heal. He went on with the bathing every evening for about 
three weeks, when the sores rather began to look worse; I then sus- 
pected that the venereal disposition was become predominant, and I 
ordered the friction as before. In about a fortnight the first buboes 
healed, but the second suppurations were not yet healed; then I sup- 
posed it to be entirely the new formed disease, and he went into the 
country, where I desired he might go into the open sea every day, as 
he then could have an opportunity, which he did, and got perfectly 
well, and has continued so. 

This case plainly shows that there was another disposition formed 
besides the venereal, which was put into action by the venereal irri- 
tation. 

I have seen some buboes most exceedingly painful and tender to 
almost every thing that touched them, and the more mild that the 
dressings were, the more painful the parts became. 

In some the skin seems only to admit the disease; ulceration going 
on in the surrounding skin, while a new skin forms in the centre, 
and keeps pace with the ulceration, forming an irregular sore like a 
worm-eaten groove all round. This, like the erysipelatous inflamma- 
tion, as also some others, appears to have only the power of contami- 
nating the parts that have not yet conie into action; and those that 
have already taken it seem to lose the diseased disposition, and hea! 
readily. 

In some they spread to an amazing extent, as the following case 
shows, the circumstances of which are very remarkable; 

A young gentleman, aged eighteen years, in consequence of a ve- 
nereal infection, had two buboes, which were both opened. They 
were treated in the usual manner, and at first put on a favourable ap 
pearance; but, when they were nearly healed, they began to ulcer* 
ate at their edges, and spread in all directions, rising above the pubes 
almost to the navel, and descending upon each thigh. His nights 
became restless, and his general health was affected. A great va- 
riety of medicines were tried, particularly mercury in different forms, 
with little or no effect. Extract of hemlock did more good than any 
thing else, and was taken in unusual quantities. An ounce was 
swallowed in the course of the day for some time, which was after- 
wards increased to an ounce and a half, two ounces, and even two 
ounces and a half. It produced indistinct vision and blindness, loss 
of the voice, falling of the lower jaw, a temporary palsy of the ex- 
tremities and once or twice a loss of sensation; and notwithstanding 
he was almost every night in a state, as it were, of complete intoxica- 
tion from the hemlock, his general health did not suffer, but, on (lie 
contrarv, kept pace in its improvement with the ulcers. They could 
not however, be healed bv the hemlock; and, among many other 
things -/Ethiop's mineral and Plummer's pill were liberally given, 



260 OF BUBO. CHAP. V. 

seemingly with advantage. Recourse was had to the hemlock from 
time to time. A great many different kinds of dressings were made 
trial of, none of which were found to exceed dry lint. The ulcers 
were nearly all healed, after having tormented him upwards of three 
years, when, committing some irregularities in diet, and the sores 
getting worse, he returned to the extract of hemlock, which he had 
for some time laid aside, and of himself swallowed in the course of 
the morning ten drams. This quantity was only the half of what 
he had formerly taken in twenty-four hours, but his constitution had 
been at that time gradually habituated to the medicine. The ten 
drams produced great restlessness and anxiety; he dropt insensible 
from his chair, fell into convulsions, and expired in two hours. 

To return to the cure of buboes. Where they only become 
stationary, and appear to have but little disposition to spread, (which 
is most common,) and where perhaps a sinus or two may be found 
running into them from some other gland, I have often seen them 
give way to hemlock sooner than to any thing I am acquainted with, 
and especially if joined to the bark. If the hemlock is applied both 
internally and externally it answers better. 

Sarsaparilla is often of singular service here, as well as in other 
cases, arising seemingly from the same cause; and i have seen sea- 
bathing of great service, as also sea-water poultice. 

At the Lock Hospital they use gold-refiner 1 s water as an applica- 
tion, which is of service in some cases. Dr. Fordyce recommends 
the juice of oranges to be drunk in large quantities, which I have 
seen good effects from in some cases. The mezereon is, in some in- 
stances, of singular use. 



The treatment of bubo is so amply stated in this part of our au- 
thor's work, that I shall make only a single remark. 

In all cases of open buboes, when there is sufficient reason to be- 
lieve them venereal, the patient should be treated with mercury, so 
as to excite a considerable degree of irritation; unless the parts should 
show a clean, fiery, red appearance, accompanied with extreme ten- 
derness, and a disposition to spread, or, as it is usually called, to be- 
come phagedaenic. 

In these cases we may be certain the action going on is not only not 
venereal, but that it is the effect of the mercury, the use of which 
should instantly be stopped. 

But in all other cases, if we think it necessary to salivate it is 
best to doit effectually; after which, we maybe satisfied, that what- 
ever difficulties occur in healing the bubo, are not from the venereal 
virus. The number of parts concerned in the open bubo, their dif- 
ferent forms and actions, renders it extremely difficult, if not impos- 
sible, to determine by the eye, whether it is venereal, unless those ap- 
pearances are present which we have just remarked, as consequent 



CHAP - v - OF BUBO. 261 

on high mercurial irritation. In all other cases we must judge very 
much by the history; and to render this satisfactory, the mercu- 
rial course should be such as we may depend on for superseding 
the venereal action. After this we must act according to circum- 
stances. 

It is true that after the effects of a violent mercurial course have 
subsided, some buboes remain in a tedious chronic state, and are 
even afterwards cured by mercury. This has given rise to the opi- 
nion that they must have been venereal, as if mercury would not 
supersede a chronic local disease unless it were venereal. In short, 
the treatment must be, as Mr. Hunter seems to admit, in great mea- 
sure, experimental. The case related in page 257 should be read 
with much attention. It shows the great modesty of the author, and 
also how fallacious that judgment must be which considers only the 
accidental success of individual cases. It is probable this patient 
owed his cure to some little change in his constitution, which first 
showed itself by what he called a " little cold;" that this change in- 
duced a new action on an indolent sore, which ended in recovery, 
without the inconvenience and uncertain consequence of a mercu- 
rial course. It may be urged, that if such a change is all that is re- 
quired, mercury will at any time produce it; but we are to recollect, 
if the mercurial phagedaena exists, the exhibition of mercury, instead 
of producing a change, will exasperate the disease. If the ulceration 
is become stationary or indolent, mercury may and sometimes does 
succeed; but as there is always danger of reviving the mercurial ac- 
tion, that remedy should rather be the last, than the first, to which 
we should apply. 



262 OF THE LUES VENEREA. CHAP. I, 



PART VI. 



Of Lues Venerea. 

INTRODUCTORY REMARKS. 

It may not be amiss, before we enter on this part of the work, to 
remind some few of our readers, that lues venerea, syphilis, and second- 
ary symptoms, are used by Mr. Hunter as synonymous terms, none of 
thembeing ever applied to chancre or gonorrhoea, but to those symp- 
toms only which arise in consequence of absorption. The old wri- 
ters, from the time of Austruc, used the terms, first infection, and 
second infection; the last of which they called confirmed pox. These 
remarks are no otherwise important, than as the knowledge of 
them may relieve the reader, if the term should happen to be anti- 
cipated. 

It will be necessary to avoid confounding the expressions of pri- 
mary and secondary symptoms, with those of first and second order 
of parts. This language is peculiar to Mr. Hunter, and perhaps was 
necessary, with some other new expressions, to describe a series of 
actions, in the order in which they usually follow each other. These 
and some other terms I shall endeavour to elucidate in the order 
in which they occur, trusting to the candour of the reader who 
is previously acquainted with Mr. Hunter's doctrine, if what 
may be^ new to others should prove prolix and uninteresting to 
himself. 



CHAP. I. 



Of the Lues Venerea. 



The lues venerea, I have already observed, arises in consequence 
of the poisonous matter being absorbed and carried into the common 
circulation. This form of the disease, which I have called the con- 



263 



OP THE LUES VENEREA. CHAP. I. 



stitutional,* would appear to be much more complicated, both in the 
different ways in which it may be caught, and in its effects when 
caught, than either a gonorrhoea or chancre. It generally arises from 
the local complaints before taken notice of, the matter being absorb- 
ed and carried into the constitution. The matter, however, appears 
to be capable of being taken into the constitution by simple applica- 
tion, without first having produced either of the before-mentioned 
local effects, as I observed in treating of the formation of the bubo; 
but this seems to be only when it is applied to some particular parts 
of our body, such as may be called a half internal surface, as the 
glans penis. I think it is not capable of being received by the ab- 
sorbents of the sound skin; but this is matter only of opinion. 

It may likewise be received into the constitution by being applied 
to common ulcers, although not necessarily rendering these ulcers 
themselves venereal; also by wounds, as has been observed; but, I 
believe, always previously producing ulceration in the wound. 

Many other modes of infection have been supposed, but, I be- 
lieve, erroneously; such suppositions most probably having taken 
their rise from ignorance or deceit, two great sources of error in 
this disease. 

It is most likely, that contamination takes place about the begin- 
ning of the local complaints, especially when that is a chancre; for 
there is in most cases less chance of its happening afterwards, because 
the patient commly flies to medicine, which generally becomes a pre- 
vention of contamination. For if it could take place through the 
whole time of the cure, we should have the parts contaminated at 
different periods, coming into action at different times, each accord- 
ing to its stated time, although in similar parts both in their nature 
and other circumstances; but as these similar parts do not vary much 
in the time of coming into action, it is reasonable to suppose that 
they were contaminated at or near the same time, and therefore that 
no contamination takes place in the time of the cure, although we 
may suppose that the power of absorption is equally strong then as 
at any other time. 

In cases of contamination from a gonorrhoea, where no mercury 
has been taken, we might expect this irregularity in similar struc- 
tures- but as contamination so seldom takes place in this way, we 
have not a chance of great variety from such; however, it would be 

• The term constitutional is, perhaps, not strictly a proper term ; for by consti- 
tutional chsease strictly, I would understand that, in Which every part of the 
bodvUact^n one way, as in fevers of all kinds either = ajet.c or ongnal; 
hut "the venereal poison appears to be only diffused through the en dilating 
but the venerea^ po , t to assumethe venerea: 

fluids, and, as ,ti ^J°™£g££ and takes place in different parts in regu- 
acUon, which action* P^ecuy loc ^ ^ ^^ ^.^ ^ 

most every function may be perfect. 



264 OF THE LUES VENEREA. CHAP. I. 

worth while to ascertain the matter, which from a great many cases 
might be done. 

Without being very exact in ascertaining the different proportions 
in those who have the lues venerea originating from the three several 
modes above described, I think we may venture to say from general 
practice or experience, that where one contracts it from the first 
cause, that is, where no local effects have been produced, a hundred 
have it from the second, or gonorrhoea; and where one has it from the 
second, a hundred have it from the third, or chancre; and perhaps 
not one in five hundred who have connection with venereal women, 
have it in the first way, and not one in a hundred have it from the 
second; while not one in a hundred would escape it from the third, if 
the means of prevention were not made use of in the common method 
of cure of the chancre. 



I suspect that Mr. Hunter admits the different modes of absorption, 
and subsequent contamination mentioned in the beginning of this 
chapter, that is, without previous chancre or gonorrhoea, rather as 
events which may have happened, than as such as he had witness- 
ed. The cases of inoculated small-pox, related with so much accu- 
racy by Mr. Whateley,* may perhaps be brought as proofs, that con- 
stitutional symptoms may appear without a primary affection on the 
part to which the matter of a morbid poison has been applied. I can 
however assert, that in the numbers inoculated at the Small-Pox 
Hospital, Ave have never found reason to suspect a subject has receiv- 
ed the infection by inoculation, without the production of a previous 
local pustule on the part. Nor do I recollect any author besides Mr. 
Whateley that has met with the incidents he describes. This, it 
may be urged, should be imputed to that gentleman's greater ac- 
curacy. I am ready to admit it, but must be allowed to make 
a few remarks on the cases, without suspecting the accuracy of the 
writer. 

The first cases were two children, one at the breast, the other four 
years old. The inoculated part suppurated in the last only; but both 
sickened at the same time. Now supposing, for argument's sake, 
that in the youngest the inoculation failed, and that the child took 
the casual disease by inhaling the effluvia from the lancet, it will not 
be impossible to account for the two sickening at the same time, be- 
cause it is most commonly found that infants at the breast pass 
through the disease under inoculation faster than those who are older; 
perhaps from being continually kept in a warm atmosphere, or nourish- 
ed by one who at these times is generally taught to indulge in a more 
generous diet. 

See Memoirs of the Med. Soc. vol. v. p. 159. 



SECT. I. OF THE LUES VENEREA. 265 

In the two other cases, we are not informed of the respective ages of 
the children, hut the one in whose arm the inoculation succeeded, 
sickened a day earlier than the other. This difference, though worth 
marking, certainly must not be considered as equal to what usually 
occurs between the inoculated and casual disease. On the whole, 
however, I think we may, without any breach of candour, wait the 
confirmation of this important question, by the appearance of other and 
similar cases. 

There is one way in which we may be deceived, by suspecting lues 
venerea, without a previous local injury, that is, by absorption from 
a gonorrhoea, the inflammation, of which has been slight, and the ac- 
tion of which has been superseded by one of those causes before men- 
tioned [see page 91,] so slightly as to have escaped the notice of 
the patient. This is more likely, and I believe does often occur in 
females who arc accustomed to increased secretions on those parts, 
without suspecting any contagious origin. Another source will be 
pointed out when we come to consider " diseases resembling lues ve- 
nerea," two cases of which arc anticipated in the second section of 
this chapter, p. 271,272. 

Mr. Hunter has remarked in another place, that it is most proba- 
ble, when syphilis is induced by absorption from the primary sores, 
such an event happens early in the disease. This is most probable, 
because, after a time the constitution must become more habituated 
to it. On this account, I suspect, he greatly overrates the number 
who would show the secondary symptoms, even if no means were 
used to prevent them. This opinion is confirmed by the numbers we 
often see in the hospitals, in the worst stages of primary symptoms, 
without any secondary symptoms. 



SECTION I. 

Of the Nature of the Sores or Ulcers proceeding from the 
Lues Venerea. 

In consequence of the blood being contaminated with real vene- 
real pus, it might naturally be supposed, that the local effects arising 
therefrom would be the same with the original which produced them; 
but from obscrvatiou and experiment I have reason to believe that 

this is not so. 

In considering this subject, we may first observe, that local effects, 
from the constitution, are all of one species, that is, ulcers, let I j 
surface upon which they appear be what it will, whether the throat 

r) 



266 OF THE LUES VENEREA- CHAP. I. 

or common skin; which is not the case in the local application of the 
matter in gonorrhoea and chancre; for there I observed that it pro- 
duced effects according to the nature of the surfaces. Now if the 
matter, when in the constitution, were to act upon the same specific 
principles with that which is applied, we should have gonorrhoeas 
when it attacks a canal; sores or chancres when it attacks other sur- 
faces; but it has never been yet known to produce a gonorrhoea from 
the constitution, though this has indeed been suspected. For some 
gonorrhoeas, the origin of which has not been clear, and which have 
not easily given way to the common methods of cure, have been 
supposed to have arisen from the constitution. Whenever the dis- 
ease affects the mouth and nose, it ha* always been looked upon as 
producing a true chancre; yet even here I find that such ulcers in 
their first appearance are very different from chancres. The true 
chancre, I observed, produces considerable inflammation, which of 
course brings on quickly suppuration, attended often with a great 
deal of pain; but the local effects of the constitution are slow in their 
progress, attended with little inflammation, and are seldom or ever 
painful, except in particular parts. However, this sluggishness in 
the effects of the poison is more or less according to the nature of the 
parts which become diseased; for when the tonsils, uvula, or nose, 
are affected, its progress is rapid, and the sores have more of the 
chancre in their appearance than when it affects the skin; yet I do 
not think that the inflammation is so great in them as in chancres that 
are ulcerating equally fast. 

It has been supposed that even all the secretions from the contami- 
nated blood could be affected so as to produce a like poison in them; 
and as the parts of generation are thrown in the way of receiving it, 
when fresh contracted, so they still lie under the censure of having it 
returned upon them from the constitution. Hence it has been sup- 
posed that the testicles and vesiculae seminales may be affected by 
the disease; that the semen may become venereal, may communicate 
the disease to others, and, after impregnation, may even grow into a 
pocky child: but all this is without foundation; otherwise, when a 
person has the lues venerea, no secreting surface could be free from 
the state of a gonorrhoea, nor could any sore be other than venereal. 
Contrary to all which, the secretions are the same as before; and if a 
sore is produced by any other means in a sound part, that sore is not 
venereal, nor the matter poisonous, although formed from the same 
blood. 

The saliva, in the case of a mad dog, being a natural secretion 
rendered poisonous, may be brought as an argument in contradiction 
to this theory; yet it is easily accounted for, and might be produced 
rather as an argument in support of it. In the dog, there is an irri- 
tation peculiar to the hydrophobia in the salivary glands; but the 
dSier and natural secretions of the same dog are not capable of civ- 



8 ^ CT - I- OF THE LUES VENEREA. 267 

ing this infection, because they are not susceptible of the same speci- 
fic irritation. 

The breath and sweat are supposed to carry along with them con- 
tagion. The milk of the breast is supposed to be capable of contain- 
ing venereal poison, and of affecting the child who sucks it ; but there 
are several reasons which overturn these opinions. First, we find 
that no secretion is affected by this poison, excepting where the se- 
nding organs have been previously affected by venereal inflammation 
or irritation, or its specific mode of action. Again, if they were con- 
taminated so as to produce matter similar to that of an ulcer in the 
throat, such matter would not be poisonous, nor possess a power of 
communicating the disease, as will be explained more fully hereafter. 
Further, true venereal matter, even when taken into the stomach, 
does not affect either the stomach or constitution, but is digested; as 
was evident in the two following cases: 

A gentleman who had chancres which discharged largely, used to 
wash the parts with milk in a tea-cup with some lint, and generally 
let the lint lie in the cup with the milk. A little boy in the house 
stole the milk and drank it; but whether or not he swallowed the 
lint was not known. No notice was taken of this by the gentleman, 
either to the family or the boy; and attention, unknown to the family, 
was paid to the boy even for years, but nothing happened that could 
give the least suspicion of his having been affected either locally in 
the stomach or constitutionally. 

A gentleman had a most violent gonorrhoea, in which both the in- 
flammation and the discharge were remarkably great. He had also 
a chordee, which was very troublesome at night. In order to cool 
the parts, and keep them clean, he had a small basin of milk by the 
bed-side, in which, when the chordee was troublesome, he got up 
and dipped or washed the penis. This operation he frequently re- 
peated during the night. Under such complaints he allowed a young 
lady to sleep with him. Her custom was to have by the bed-side a 
basin of tea to drink in the morning before she got up; but unfortu- 
nately for the ladv, she drank, one morning, the milk instead of the 
tea. This was not known till she got up, which was five or six 
hours afterwards. I was sent for directly, and in the mean time she 
endeavoured to vomit, but could not. I ordered ipecacuanha, which 
proved slow in its operation. She vomited, but it was more than 
eight hours after drinking the milk and water, and what came up was 
nothing but slime, mucus, or water, the milk being digested. I was 
attentive to what might follow; but nothing uncommon happened, at 
least for many months. 

It i* also supposed, that a foetus, in the womb of a pocky mother, 
may be infected by her. This I should doubt very much, both from 
what may be observed of the secretions, and from finding tha even 
the matter from such constitutional inflammation is not capable of 
communicating the disease. However, one can conceive the bare 



OF THE LUES VENEREA. CHAP. I. 

possibility of a child being affected in the womb of a pocky mother, 
not indeed from the disease of the mother, but from a part of the same 
matter which contaminated the mother, and was absorbed by her; 
and whether irritating her solids to action or not, may possibly be 
conveyed to the child, pure as absorbed; and if so, it may affect the 
child exactly in the same way it did or might have done the mother. 
This idea has been carried still further; for it has been supposed that 
such a contaminated child could contaminate the breasts of a clean 
woman by sucking her; the possibility of which will be considered 
presently. We may observe, that even the blood of a pocky person 
has no power of contaminating, and is not capable of giving the dis- 
ease to another even by inoculation; for if it were capable of irritating 
a sound sore to a venereal inflammation, no person that has this mat- 
ter circulating, or has the lues venerea, could escape having a vene- 
real sore whenever he is bled or receives a scratch with a pin, the 
part so wounded turning into a chancre. For if venereal matter be 
on the point of the lancet, or on the point of the pin, the punctures 
must become chancres. 



This section is a little confused, by beginning with " the nature of 
the sores or ulcers proceeding from lues venerea or secondary symp- 
toms," next hinting at their contagious property, and then proceeding 
to a detail of some consequences, or probable consequences, from the 
matter of primary sores. The three last and half the preceding para- 
graph, relating to the matter of primary sores, should have been in- 
cluded under that part of the work in which the different modes of pri- 
mary infection are considered. The result of the inquiry, however, 
being altogether negative, renders it of too little importance to make 
any transposition necessary; but it is worth remarking how generally 
the error has prevailed, that Mr. Hunter denied that the foetus in utero 
could be infected: yet in this passage we see him not only admitting 
such a possibility, but explaining how it might take place. More 
than one author has been at the pains to relate cases in which the 
foetus in utero has been affected with small-pox, in order to prove, by 
analogy, the fallacy of Mr. Hunter's opinion concerning syphilis: not 
aware that Mr. Hunter was the first person who gave a satisfactory de- 
scription of such a case, which is published in the Philosophical 
Transactions* 



SECT - u OP THE LUES VENEREA jli.O 



SECTION II. 

Of the Matter from Sores in the Lues Venerea, compared with that 
from Chancres and Buboes. 

When the matter has affected the constitution, it from thence pro- 
duces many local effects on different parts of the body, which are in 
general a kind of inflammation, or at least an increased action occa- 
sioning a suppuration of its own kind. It is supposed, that the mat- 
ter, produced in consequence of these inflammations, similar to the 
matter from a gonorrhoea or chancre, is also venereal and poisonous. 
This I believe till now has never been denied; and, upon the first 
view of the subject, one would be inclined to suppose that it really 
should be venereal: for first, the venereal matter is the cause; and 
again, the same treatment cures both diseases; thus mercury cures 
both a chancre and a lues venerea; however, this is no decisive 
proof, as mercury cures many diseases besides the venereal. On the 
other hand, there are many strong reasons for believing that the mat- 
ter is not venereal. There is one curious fact, which shows it is 
either not venereal, or, if it be, that it is not capable of acting in some 
respects on the same body or same state of constitution as that mat- 
ter does which is produced from a chancre or gonorrhoea. The pus 
from these latter, when absorbed, generally produces a bubo, as has 
been described; but we never find a bubo from the absorption of mat- 
ter from a pocky sore; for instance, when there is a venereal ulcer 
in the throat, we have no buboes in the glands of the neck; when 
there are venereal sores on the arms, or even suppurating nodes on 
the ulna, there are no swellings of the glands of the arm-pit; although 
such will take place if fresh venereal matter is applied to a common 
sore on the arm, hand, or fingers. No swelling takes place in the 
glands of the groin from either nodes or blotches on the legs and 
thighs. It may be supposed that there is no absorption from such 
sores; but I think we have no grounds for such supposition. Its 
mode of irritation, or the action of the parts affected, is very different 
from what happens in the chancre, gonorrhoea, or bubo, being hard- 
ly attended with inflammation, which in them is generally violent. 

It might be supposed, that a constitution, truly and universally 
pocky, is not to be affected locally by the same species of matter; 
but, from the following experiments, it would appear that the matter 
from a gonorrhoea or chancre is capable of affecting a man locally 
that is already poxed; and that matter from pocky sores, arising from 
the constitution, has not that power. 

A man had been affected with the venereal disease a long time, 
and had been several times salivated, but the disease still broke out 
anew. He was taken into St. George's Hospital, affected with a 



270 OF THE LUES VENEREA. CHAP. I. 

number of pocky sores; and before I put him under a mercurial 
course, I made the following experiment: I look some matter from 
one of the sores upon the point of a lancet, and made three small 
wounds upon the back where the skin was smooth and sound, deep 
enough to draw blood. I made a wound similar to the other three, 
•with a clean lancet, the four wounds making a quadrangle; but all the 
wounds healed up, and none of them ever appeared afterwards. 

This experiment I have repeated more than once, and with the same 
result. It shows that a pocky person cannot be affected locally with 
the matter proceeding from the sores produced by the lues venerea. 
But to see how far Veal venereal matter was capable of producing 
chancres on a pocky person, I made the following experiment: 

A man, who had Venereal blotches on many parts of his skin, was 
inoculated in sound parts with matter from a chancre, and also with 
matter from his own sores. The wounds inoculated with the matter from 
the chancres became chancres; but the others healed up. Here then 
was a venereal constitution capable of being affected locally with fresh 
venereal matter. This experiment I have likewise repeated more 
than once, and always with the same effect. 

I ordered a person, at St. George's Hospital, to be inoculated with 
the matter taken from a well marked venereal ulcer on the tonsil, 
and also with matter from a gonorrhoea, which produced the same 
effects as in the preceding experiment; that is, the matter from the 
gonorrhoea produced a chancre, but that from the tonsil had no effect. 

A woman, aged twenty-five, came into St. George's Hospital, 
August 21, 1782, with sores on her legs, and blotches over her body. 
Her husband gave her the venereal disease, December, 1781. Her 
symptoms then were, a discharge from the vagina, and a small swell- 
ing of the glands of the groin, which were painful. She had taken 
some pills supposed to be mercurial February, 1782, about three 
months after being infected, the discharge stopped: but the swelling, 
which had been gradually increasing ever since its first appearance, 
had now suppurated. She applied some ointment to it which was 
brought to her by her husband, and in two months it got well, that is. 
in April, 1782. After the bubo got well, a discharge from the vagina 
came on, for which she took more of the same pills she had taken be- 
fore. After this time blotches came out over her "whole bodv; some 
about her legs, under her arms, and upon her nipples, ulcerated. 

Twins, which she brought forth at eight months, in March, 1782, 
at the time the bubo was healing, had blotches upon them at their 
birth, and died soon after. 

Another girl, about two years old, whom she suckled, was also 
covered with blotches when she came to the hospital. 

To ascertain whether her secondary ulcers were infectious, that 
is, whether the matter of them would have the specific effects of ve- 
nereal matter, she was inoculated with some matter from one of her 
own ulcers, and with some matter from a bubo of another pel-sob 



SECT - "• OF THE LUES VENEREA. 271 

where mercury had not been used. This was done, September 18, 
1782. September 19, the puncture, where she was inoculated with 
her own matter, gave her pain three hours from the time of inocula- 
tion, and the day following inflamed a little. The other had not 
then inflamed at all. 

September 20, both the punctures had suppurated, and had the 
appearance of a small-pox pustule; they spread considerably, and 
were attended with much inflammation. That from her own matter 
healed with common poultices, and ointments without mercury; but 
the other, although treated in a similar way, continued in the same 
state, attended with much pain and inflammation. 

September 22, the child was inoculated with some matter from 
one of its own ulcers, and with some common pus. The punctures 
both inflamed in a small degree; but neither of them suppurated. 

The mother and the child went into the ward appropriated to sali- 
vation, October 21, 1782. The child took no mercury. It was 
supposed that its gums became a little sore; and the blotches got 
well. 

During the time that the mother was using mercury, the ulcer 
from inoculation began to get well, and all her venereal symptoms 
disappeared. What shall we say to this case? Were the blotches 
venereal? There was every leading circumstance to make us think 
so; and our opinion was strengthened by the method of cure. H they 
were venereal, my opinion, that the constitutional appearances of the 
disease do not. produce matter of the same species that produced 
them, is confirmed. If they were not venereal, then we have no ab- 
solute rule by which to judge in such cases. 

It has been supposed and asserted from observation, that ulcers in 
the mouths of children from a constitutional disease, which consti- 
tutional disease has been supposed to be derived from the parent, 
have produced the same disease upon the nipples of women who 
had been sucked by them; that is, the children were contaminated 
either by their mother or father's having the disease in form of a lues 
venerea, of which I have endeavoured to show the impossibility. If, 
however, it were possible to contaminate once in this way, it would 
be possible to contaminate for ever. 

How far the observations, upon which the before-mentioned opi- 
nion is founded, have been made with sufficient accuracy to overturn 
those which I made with a view to ascertain the truth, I know not. 
But, from a more accurate investigation of some of those cases, which 
were by most of the faculty called venereal, they appeared evidently 
not to be such. To say what they were, would lead us into the 
consideration of other diseases. The following case may lessen our 
faith in the histories of such as have been supposed to be venereal. 

Before I describe the case, I shall first mention some of the cir- 
cumstances leading to it. 

A child was supposed to have infected its nurse with the venereal 






272 OF THE LUES VENEREA. CHAP. I, 

disease The parents had been married about twelve years, when 
this child was bora. The father was a very fond husband, and the 
mother a mild and most affectionate woman. The father had a ve- 
nereal gonorrhoea two years before he married, that is, fourteen years 
before the birth of the child. About nine months after marriage they 
had a child, and afterwards a second, both of whom were extremely 
healthy at birth, and still continue so. The mother fell into a weak- 
ly state of health, and miscarried of her third child at the end of five 
months. The fourth child was born at seven months, but was puny, 
weak, and had hardly any cuticle when born. It was immediately 
after birth attacked with a violent dysentery. It died in a few days, 
and was opened by me. The whole skin was almost one excoriated 
surface. The intestines were much inflamed and thickened. 

With her fifth child, from great care, she went eight months, and 
it was now hoped that she might go the fuii time, and also that this 
child might be more healthy than the former. When she was deli- 
vered, the child was very thin, but free from any visible disease. 

Some days after birth it became blistered in a vast number of 
places on its body, which blisters were filled with a kind of matter, 
and, when they broke, discharged a thinnish pus. The inside of the 
mouth was in the same condition. Bark was given to the nurse. 
Bark in milk was given to the child by the mouth; and it was fo- 
mented with a decoction of bark; but, in about three weeks after 
birth, it died. 

Some weeks after the death of the child, the nurse's nipple, and 
the ring round the nipple, inflamed, and sores or ulcers were formed 
with a circumscribed base.* They were poulticed, but without be- 
nefit. She also complained of a sore throat; but the sensation she 
complained of was so low in the throat that no disease could be seen. 
A swelling took place in the glands of the arm-pit, but they did not 
suppurate. She applied to a physician, and, according to the ac- 
count which she gave, he pronounced that her disease was venereal, 
and that she had given suck to a foul child; and he ordered ten 
boxes of mercurial ointment to be rubbed in on her legs and thighs, 
eight of which had been used when I saw her; and then her mouth 
was become extremely sore. 

These circumstances came to the ears of the family, and an alarm 
took place. The husband went from surgeon to surgeon, and from 
physician to physician, to learn if it was possible for him to have the 
disease for fourteen years, and never to have perceived a single symp- 
tom of it in all that time: or if it was possible he could get chil- 
dren with the disease now, when the two first were healthy. He 
also wanted to know, if it was possible for his wife to have* caught 
the disease from him under such circumstances; and also, if she 
could breed children with this disease, although she herself never 

* She had but one breast that gave milk. 



SECT. II. OF THE LUES VENEREA. 273 

had a single symptom of it. If we take all the above-mentioned 
circumstances as facts, the conclusion is, that it was impossible there 
could be any thing venereal in the case; but as they could not be 
absolutely proved to be facts, there must remain a doubt in the mind, 
a something still to be proved. 

Now let us consider the result of the case. The nurse's mouth 
was become extremely sore from the mercury when I first saw her. 
I desired that Mr. Pott might see her along with me; and it was the 
opinion of us both, that the sores on the nipple, and around it, were 
not venereal; but it was alleged, that, as she had taken mercury, 
their not having a venereal appearance now was ovving to that cause. 
The bark was given, as also the sarsaparilla, but the sores did not 
heal, nor did they become worse; nor was the mouth better by leav- 
ing off the mercury. I ordered the hemlock; but that appeared to 
have no effect. In the mean time eruptions broke out on the skin. 
The skin of the hands and fingers peeled off; the nails of both fin- 
gers and toes separated; and sores formed about their roots, which 
were all supposed (by many) to be venereal. But some of them ap- 
pearing while the constitution was full of mercury, and others dis- 
appearing without any further use of that medicine, I judged that 
they were not venereal. We suspected that her mode of living was 
such as contributed greatly to the continuance of her first complaint, 
and gave rise to the new ones; for she looked dejected and sallow. 
She was desired to go into an hospital, which she did. As soon as 
she got into a warm bed, and had good wholesome food, she began 
to mend, and in about five or six weeks she had become fat and al- 
most well; the sore only about the root of the nail of the great toe 
had not healed: but that appeared now to be owing to the root of the 
nail being detached, therefore acting as an extraneous body. She 
came out of the hospital before this toe had got well; and, returning 
to her old poor mode of living, she had a return of the soreness in 
the mouth; however, she mended at last without the use of more 

mercury. 

This case I shall further consider when on diseases resembling the 

venereal. 

The following case will further prove that we often suspect com- 
plaints to be venereal when they really are not. 

A Gentleman bad for some time blotches on his skin; the face, 
arms le^s, and thighs, were in many places covered with them; and 
they were'in their different stages of violence. In this situation he 
applied to me; and I must own they had a very suspicious appear- 
ance. I asked him what he supposed these blotches were; he said 
he supposed them to be venereal. I asked him when he had a recent 
venereal complaint? He told me not for above twelve months. I then 
asked him how long he had had the blotches? and the answer was, 
above six months. As this was a suffit ient time for making observa- 
tions upon them that might ascertain better than the mere appearance 

w m 



274 OF THE LUES VENEREA. CHAP. I. 

what they were, I asked him if any of the blotches that came first 
had disappeared in that time; and he said many; I desired to see 
where those had been; and on examination I found only a disco- 
loured skin, common to the healing of superficial sores. I then de- 
clared to him, that they were not venereal; for if they had arisen 
from that source, none of them would have disappeared. He now 
informed me, that he had been taking mercury; and this informa- 
tion obliged me to have recourse to further inquiries; and I therefore 
asked him, whether, while he was taking mercury, many of the first 
got well? The answer was yes. And was the cure of those im- 
puted to mercury? The answer was again in the affirmative. I 
then asked him, if, while he was taking the mercury, which appear- 
ed to have cured some, those that now remained arose ? Yes. My 
next question was, how long had he taken mercury? He said for 
six months. I then declared they were not, nor ever had been ve- 
nereal. I then asked him, what was now the opinion of his sur- 
geon? He said, that his opinion still was, that they were venereal, 
and that he should go on with the mercury. I advised him to take 
no medicines whatever; to live well, avoiding excess, and to come to 
me in three weeks; which he did, and then he was perfectly well, 
only the skin was stained where the blotches had been. He now 
asked me, what he was next to do? I told him he might go to the 
sea and bathe for a month. This he did, and returned well and 
healthy, and has continued so. 



That the matter from secondary sores is different from primary 
might have been inferred from the difference in the appearance and 
progress of the two. It was, however, presumed, as a matter of 
course, that the secondary matter was contagious. The proof of the 
contrary, being founded on experiment, will not be questioned by 
those who are acquainted with the accuracy of the author, or the 
publicity with which the experiments were performed. 

Two cases of diseases resembling lues venerea are here intro- 
duced, merely to show the fallacy of many others, on which the opi- 
nions have been founded of the infectious nature of matter from se- 
condary sores. The subject of diseases resembling lues venerea is 
considered more at large hereafter. 



SECT. III. OF THE LUES VENEREA. 275 



SECTION III. 

Of the local Effects arising from the Constitution considered us criti- 
cal — Symptomatic Fever. 

How far the eruptions or local effects of this disease, arising from 
the constitution, are an effort of nature to clear herself of this dis- 
ease, is not certain. I observed, that a gonorrhoea might be produced 
by a general law in the animal economy, by which it endeavours to 
relieve itself of the irritation by producing a discharge; and that in 
chancres a breach is made in the solids for the same purpose, al- 
though this purpose is not answered in either, nature not having a 
provision against this poison. But how far a similar attempt takes 
place in a lues venerea I do not know; and if it was upon the same 
principle, the same reason might be expected to be given, why the 
constitution is not capable of relieving itself in the present instance 
that I gave, when treating of the primary affections, because in this, 
as it was in the other, the matter formed might be supposed to be 
venereal; and therefore, by being absorbed by the very surface which 
produced it, as in a chancre, it might keep up the constitutional dis- 
ease. If this were really the case, it would be very different from 
many other specific diseases; for the reason why many specific dis- 
eases cure themselves is, that the irritation cannot last beyond a stat- 
ed time; and also that in many, the patient is never susceptible of 
the same disease a second time, as in the small-pox. If this was not 
the case, a person once having the small-pox would always have 
them; for, according to one supposition, that absorption of its own 
pus keeps up the disease; and according to another, that the irrita- 
tion never wears itself out, the patient would either never be free, 
or have them repeated for ever; for his own matter would give the 
disease a second time, a third time, and so on * But the venereal 
matter, when taken into the constitution, produces an irritation which 
is capable of being continued independent of a continuance of ab- 
sorption; and the constitution has no power of relief, therefore a 
lues venerea continues to increase. This circumstance is perhaps 
one of the best distinguishing marks of the lues venerea; for in its 
ulcers and blotches it is often imitated by other diseases, which, not 
having this property, will therefore heal and break out again in some 
other part. Diseases in which this happens, show themselves not to 

* This circumstance alone is a strong proof that people cannot have the 
small nov twice, at least at any distance of time between, .f they had fair erup- 

* m T ,i st time • for if the constitution was not so altered as not to be sus- 
c-oK.b!:- of tins m-UaL, a second time, a person would have them nnmed.ately 
upon the going off of the first 



276 OF THE LUES VENEREA. CHAP. I. 

be venereal; however, we are not to conclude, because they do not 
heal of themselves, and give way only to mercury, that therefore 
they are venereal, although this circumstance joined to others gives- 
a strong suspicion of their being such. 

When the parts are contaminated by the venereal poison, we com- 
monly find fever, restlessness, or want of sleep, and often headach; 
but I believe that these symptoms are rather peculiar to the disease, 
when the second order of parts, the periosteum and bones, are af- 
fected, although they are sometimes found of the first. Do these 
symptoms arise from the local irritations affecting the constitution? 
And are they merely sympathetic? Whatever the immediate cause 
may be, they never go off till the local irritations are removed. This 
fever at first has much the appearance of the rheumatic fever; and 
after a time it partakes a good deal of the nature of the hectic. 

These symptoms often take place independent of, or unattended 
by, any local action; and when that is the case it becomes very un- 
certain what the disease is; for in cases not admitting of clear proof 
we must rest on the concurrence of circumstances. Many of these 
symptoms give way to mercury. This is probably the only concur- 
ring circumstance attending this complaint that is any proof of its be- 
ing venereal.* It rather, however, appears to militate against this 
idea, that, for the most part, a much smaller cjuantity is sufficient for 
the cure of such symptoms than what is necessary for the cure of local 
complaints. But if mercury always cured them, it would not be 
very material Avhat they are called. It is worthy of consideration, 
however, how far the venereal poison, when in the constitution, does 
or does not always produce local effects. That it in general does, we 
are certain; but whether it is ever a cause of constitutional symptoms 
simply, such as loss of appetite, wasting, debility, want of sleep, and 
fever, at last becoming hectic, is uncertain; and it is also uncertain 
whether it is ever capable of producing local actions from irritations 
only, without an alteration of the structure of the parts irritated, as 
cough, secretion from the lungs, purging, headach, sickness, pains 
in different parts of the body like rheumatic pains, but not from an 
alteration of the structure of the part taking place, as beginning 
nodes. If such effects take place, we must in such a case relv en- 
tirely on the history of the disease, and pronounce according to' pro- 
bability. Such complaints come oftener under the management of 
the physician than the surgeon, to whom I would recommend a par- 
ticular attention to this. 

The fever in consequence of the venereal irritation, like most other 
fevers, deranges the constitution, which thereupon suffers agreeably 
to its natural tendency. It is capable of producing glanduhr swell- 

* Here it is to be understood, that the circumstance of a previous srono-rliaa 
or chancre is not to be considered as strong evidence. 



SECT. III. OP THE LUES VENEREA. 277 

ings in many parts of the body, and probably many of the nodes that 
arise in the time of this fever may proceed from the fever, and similar 
to every such effect, from whatever cause, it does not partake of the 
disease which produced it, for it is not venereal: it only takes place 
in constitutions very susceptible of such action where the predisposing 
cause is strong, and probably at seasons most fitted to produce it, 
only waiting the immediate cause to put them into action, such will 
and do go away of themselves when the predisposing cause ceases, 
such as season. 



In this section, the author considers the sympathetic fever, or, as 
he calls it in the Introduction, " the whole constitution sympathizing 
with a local disease;" and points out the manner in which it becomes 
first the symptomatic, and afterwards the hectic fever. 

It may be necessary to remark, that all morbid poisons, however 
violently the constitution may sympathize, are only local in their ac- 
tion. The small -pox, and other exanthemata, are confined to parts of 
the integuments and throat; lues venerea to the same parts, and to 
certain bones and their periostea. On the commencement of these 
local actions, the constitution sympathizes. In other words, such 
new actions can scarcely take place, without in some measure af- 
fecting the general health. In the exanthemata this fever is called 
symptomatic, that is, a symptom of the change which is taking place. 
In the commencement of lues venerea, it may be called by the same 
term; but if the disease continues, an attempt will be made by the con- 
stitution to relieve itself. This attempt, like all new actions, will show it- 
self by such a change in all the functions as is denominated fever. The 
paroxysm subsides, but the irritation still remaining, the same attempt 
at relief is renewed; that is, the fever returns, and this retiirn of fever 
continues at intervals, somewhat uncertain, till the disease is sub- 
dued by art, that is, till a mercurial irritation is excited, sufficient to 
supersede the venereal. Hence the first paroxysm of fever that is 
excited may be called symptomatic, inasmuch as it is a symptom of 
the approaching local action: but the subsequent paroxysm occurs so 
often as to be very properly styled habitual or hectic— See the In- 
troduction. 



278 OP THE LUES VENEREA. t.HAP. I 



SECTION IV. 

Of the local and constitutional Forms of the Disease never interfering 
with one another. 

I observed, when treating of the gonorrhoea and chancre, that, 
when occurring in the same person, the one neither increases the 
symptoms nor retards the cure of the other. And it may also be ob- 
served, that the chancre or gonorrhoea, and the constitutional form of 
the disease, meeting in the same person, do not interfere with each 
other, either in their symptoms or cure. 

To explain these effects more fully, let me observe, that if a 
man has a gonorrhoea, and a chancre appears some days after, 
the chancre does not either increase or diminish the gonorrhoea. 
Again, if a man has either a gonorrhoea, a chancre, or both, and a 
lues venerea ensue in consequence of either of these, neither the 
gonorrhoea nor chancre is affected by it. If a man has a lues ve- 
nerea, and gets either a gonorrhoea or chancre, or both, neither 
of them affects the lues venerea, nor are their symptoms the worse. 
Nor is the cure of either, singly, retarded by the presence of the other; 
for a gonorrhoea is as easily cured when there are chancres, as when 
there are none, even although the chancres are not attempted to be 
cured; and a chancre may be cured locally independent of the gonor- 
rhoea. Further, a gonorrhoea, chancre, or both, may be as easily cured 
when the constitution is poxed either by them, or previous to their 
appearance, as when the person is in perfect health; but the chancre 
has this advantage, that the constitution cannot be cured without its 
being likewise cured. 

The gonorrhoea and chancre indeed so far influence one another, 
as the one can be in some degree a cause of prevention of the other, 
as has been already observed; but I believe that this circumstance 
does not assist in the cure of either: yet I could conceive it might, 
each acting as a derivator to the other, without increasing its own 
specific mode of action. 



SECTION V. 

Of the supposed Termination of the Lues Venerea in other 
Diseases. 

This disease seldom or ever interferes with other disorders, or 
runs into, or terminates in any other, although it has been very much 



SECT. "VI. OF THE LUES VENEREA. 



279 



accused of doing so; for a termination of one disease in another, as I 
understand the expression, must always be a cure of the one termi- 
nated; but the venereal disease never terminates till the pro- 
per remedy is applied, and therefore never can run into any other 
disease. . 

That venereal complaints may be the cause of others, I think is 
very probable. I have seen a chancre the immediate cause of* an 
erysipelatous inflammation: but the venereal malady did not termi- 
nate in the erysipelatous inflammation; for, if it had, the chancre 
would have been cured; nor was the erysipelatous inflammation ve- 
nereal; the chancre only acted here as a common lmtator, inde- 
pendently of the specific quality of the disease as a cause. I have 
known a venereal bubo become a scrofulous sore as soon as the ve- 
nereal poison was destroyed by mercury; this was not a venereal ter- 
minating in a scrofulous affection; for in such a view the scroiula 
must have cured the venereal. The venereal disease would seem 
only to partake of the nature of such disorders as the constitution was 
previously disposed to, and may excite into action the causes ot these 
disorders. The same observation and mode of reasoning holds equal- 
ly good with respect to other diseases. The common symptoms, 
however, of the lues venerea, though in some degree according to the 
constitution, are not so much so as either in the chancre or t h< .go- 
norrhoea; for the lues venerea is attended wiffe *«T 1 ittt e nomina- 
tion, which in general partakes much more of the nature oi the con- 
stitution than any other diseased action. 



SECTION VI. 

Of the specific Distance of tlu Venereal Inflammation. 
T „avf already observed, that many specific diseases, as also those 

£2 frl observation, that the venerea. fart*. "™ "t 



280 OF THE LUES VENEREA. CHAP. I. 

proof of this fact, we find it is also confined to the glands of the 
groin, in cases of buboes, till matter is formed in them; which 
matter acts as a common irritator, and the specific is in some 
degree lost, and then the inflammation becomes somewhat more 
diffused, as happens in common inflammation. We also see 
that the same thing happens in venereal ulcers when they 
arise from the constitution: their size is at first but small, and 
they are merely local; but as the disease increases, the size in- 
creases, but still they remain circumscribed, not becoming dif- 
fused. Perhaps all poisons and specific diseases agree in this pro- 
perty of having their inflammation limited and circumscribed in a 
manner peculiar to themselves; for we find that the inflammation of 
the small-pox, measles, and chicken-pox, is each circumscribed in 
its own way. From hence it must appear, that the human body in 
general is not so susceptible of specific irritations as it is of the 
common, or what may be called the natural. But we must also con- 
sider, that the common inflammation in very healthy constitutions 
has its specific distance, although not so determined or circumscribed 
as is that of the specific in such constitutions; therefore we may rea- 
sonably suppose, that such healthy constitutions are the furthest in 
disposition from the inflammatory action; and we may also suppose 
still more so from the specific. What would appear to strengthen 
this idea is, that when the constitution is such as readily goes into 
inflammation, the more readily does the inflammation spread, every 
part being susceptible of such action; and we find that in many the 
specific also spreads, although not in so great a degree, from which 
we may suppose that the specific is always a more confined mode of 
action. I have suspected that when the body was disposed to in- 
crease the inflammation beyond the specific distance, it was of the 
erysipelatous kind, as was mentioned before, and which is to be at- 
tended to in the cure. 



We have already noticed Mr. Hunter's remarks on the specific 
distance of the inflammation induced by morbid poisons. In this 
passage he enters more on the subject, and shows that common in- 
flammation is always circumscribed in proportion to the powers of 
the constitution in resisting disease. 



SECT. VII. OP THE LUES VENEREA. 281 



SECTION VII. 

Of the Parts most susceptible of the Lues Venerea— Of the Time and 
Manner in which they are affected — What is meant by Contamina- 
tion, Disposition, undeletion — Summary of the Doctrine. 

When I assigned the causes for so great a difference in the effects 
of the same poison upon two different surfaces, as forming the gonor- 
rhoea and chancre, I then said I did not know whether similar sur- 
faces in every part of the body were equally susceptible of this irrita- 
tion, having but few comparative trials of the direct application of 
the poison to other parts besides those of generation. But it would 
appear that some parts of the body are much less susceptible of the 
lues venerea than others; and not only so, but many parts, so far as 
we know, are not susceptible of it at all. For we have not yet had 
every part of the body affected; we have not seen the brain affected, 
the heart, stomach, liver, kidneys, nor other viscera; although such 
cases are described in authors. But as there are different orders of 
parts respecting the times of the disease appearing, and as the per- 
son commonly flies .to relief upon the first or second appearance, it 
may be supposed that the whole disease in the parts actually affect- 
ed is cured before the other parts have had time to come into action, 
which will therefore be cured under the state of a disposition only, if 
we can conceive that a cure can take place before the parts have 
come into action. But if the parts visibly affected are cured, while 
those only disposed are not, and afterwards come into action, they 
would form a second order respecting time; and if these again are 
cured, and other parts under a disposition should come into action, 
such would form a third order of parts respecting time. The lungs 
have been believed to have been affected with the venereal disease, 
both from the circumstances preceding the complaint, and from the 
complaint itself being cured by mercury; and their being affected when 
the other viscera are not, may arise from their being in some degree an 
external surface, as will be explained hereafter. 

It is this form of the disease, therefore, that gives us the compara- 
tive susceptibility of parts both for disposition and action. For we 
must suppose that all parts are equally and at once exposed to the ac- 
tion of the poison; but though there may be various degrees of sus- 
ceptibility, it will be sufficient for practice to divide them into two, 
under the following appellations of first in order, and second in or- 
der, to which we may add the intermediate. 

Whether the parts that are really first affected are naturally more 
easily affected by this kind of irritation, or that some other circum- 
stance which belongs to these parts is the cause, cannot be absolutely 

N n 



252 OF THE LUES VENEREA. CHAP. U 

determined; but the matter being attentively considered, it would 
appear to be owing to something foreign to the constitution, and also 
not depending on the nature of the parts themselves; for if we take a 
view of all the parts that are first affected by this disease, when 
arising from the constitution, which I shall suppose are the parts most 
susceptible of it, we shall see that in the recent state of the disease 
these parts are subject to one general affection, while there are simi- 
lar parts of the body not affected by this disease, and not subject to 
this general affection. Probably the parts second in order may na- 
turally be as susceptible of the irritation as those first in order; but 
not being under the influence of an irritating cause, they are later in 
coming into action; and there are also probably other causes in the 
nature of the parts themselves, such as being indolent in all their ac- 
tions, and of course indolent in this, therefore later in coming into 
action. However, it is not universally the case that the parts which 
I have called first in order are always so; on the contrary, we find 
that this order is inverted in some cases, although but rarely. We 
cannot suppose that this difference arises from any active power iu 
the poison, nor any particular direction of it, but from properties in 
the parts themselves; for it maybe allowed us to suppose, that, when 
this matter has got into the circulation, it acts on all parts of the body 
with equal force; that is, it is not determined to any one part more 
than another by any general or particular power in the animal ma- 
chine; nor is the nature of the poison such as will fall more readily 
on one part of the body than another, when they are all in similar 
circumstances. That some parts therefore are more readily affected 
by it than others, owing to circumstances which are no part of the 
animal principle, nor of the poison; and also that some parts of the 
body have a greater tendency to be irritated by it in others, must be 
allowed. 

The parts that are affected by this form of the disease when in its 
early stage or appearance, which I have called first in order, are, the 
skin, tonsils, nose, throat, inside of the mouth, and sometimes the 
tongue.* When in its later state, the periosteum, fasciae, and bones, 
come into action, and these I call second in order of parts. Perhaps 
the bones come into action from the membrane being affected. 

That we may be able to account in some measure for these similar 
effects as to time in dissimilar parts, such as the skin and the tonsils, 
two very different kinds of parts, let us consider in what circum- 
stance they agree, and why they are more susceptible of this irritation 

8 The tongue is very subject to have ulcers formed on it, especially on its 
edges. They are seldom very large, nor are they often either very foul or 
have a hard basis : these are commonly supposed to*be venereal ; but I believe 
they seldom are. I do not know whether I am, or not, acquainted with the 
distinguishing marks. I never saw but one that I suspected to be either vene- 
real or cancerous, from its foul look and its hard basis. It gave way readilv to 
mercury, therefore I supposed it to be venereal 



SECT. VII. OF THE LUES VENEREA. 283 

than those parts that probably are naturally as much so, although they 
do not receive it so readily, such as the periosteum, fasciae, and 
bones. 

The most remarkable circumstance perhaps to which the external 
surface is exposed, and to which the internal is not, is cold, or a suc- 
cession of different degrees of cold. For we may observe, in general, 
that the atmosphere in which we live is colder than the human body* 
in its usual temperature, therefore the skin, &c. is continually ex- 
posed to a cold greater than what the internal parts are; and we find 
that all those parts which are most exposed to this, admit of being 
much more easily affected, or come more readily into action in this 
disease than the others. 

It is certain that cold has very powerful effects on the animal 
economy. It would at least appear to have great powers of dispos- 
ing the body for receiving the venereal irritation, and going readily 
on with it. 

From this idea we may account for several circumstances respect- 
ing this disease, as the mouth, nose, and skin, being the most frequent- 
ly affected, since they are rendered most susceptible of it from the 
causes before mentioned, and for the same reason come very readily 
into action. If this be a true solution, it also accounts for those se- 
cond in order being affected; for if the poison has contaminated parts 
which are both first in order of susceptibility and time of coming 
into action, it is natural to suppose that those parts which are most 
predisposed, as the external surfaces, shall come first into action; the 
parts exposed to cold, in the next degree, forming the second in or- 
der, come next into action, such as bones, periosteum, &c. but even 
in them it is not in every bone alike, or every part alike of any one 
bone; for it appears first in those that are in some measure within 
the power of being affected by sympathy from application of cold to 
the skin: we find that when the deeper seated parts, or the parts se- 
cond in order, come into action, such as the periosteum or bones, it is 
first in these that are nearest the external surface of the body, such 
as the periosteum or bones of the head, the tibia, ulna, bones of the 
nose, &c. nor does it affect these bones on all sides equally, but first 
on that side next the external surface. However, it would appear 
that in the bones there is another cause besides the vicissitudes of 
weather why this disease should attack them; for the periosteum of 
bones, o'r bones themselves, are not liable to be diseased on all parts 
in proportion to the distance from the skin, the periosteum which 
covers the ankles, or many of the joints, being as near the external 
surface as many other parts of the periosteum or bones that are affect- 
ed. The nature of the bones themselves, which are covered by that 

tTo?Z *£J^2E3&Z —hit neater than that of the hu- 
man bod v. 



284 OF THE LUES VENEREA. CHAP. I. 

periosteum, is somewhat different; they are softer in their texture, 
therefore they would seem to be affected in proportion to their near- 
ness to the skin, and hardness of the bones jointly; which would in- 
cline us to believe, that the bones are more easily affected, and rather 
have some influence upon the periosteum in this disease, than the 
periosteum upon them; and this susceptibility in the hard bones 
would appear to be in proportion to their quantity of earth and expo- 
sure to cold combined. 

It may be objected to this theory, that the fore part of the tibia, 
&c. cannot be really colder than the back part; but then it may be 
supposed, that it is not necessary that the part should be actually cold, 
but only within the power of sympathy. For a part that is not ac- 
tually cold is capable of being affected from its sympathising with a 
cold part in the same manner as if actually cold, although perhaps 
not in so great a degree, and therefore requires a longer time to come 
into action than if it were actually cold. We find, for example, that 
when the skin is actually cold, the muscles underneath are thrown 
into alternate action, so that we tremble, or our teeth chatter with 
cold, and yet it is possible that these muscles may not be colder at 
this time than any other; although it is most probable that they are 
really colder,* which will assist the power of sympathy. So far as 
cold can affect the actions of parts, so far also will the sympathising 
part be affected in proportion as it is nearer to the parts actually 
cold; therefore, the deeper seated parts in the veneral disease are 
later in coming into action. 

Xhe actual cold parts come first into action, then those that are less 
so, and next those that are nearest in sympathy, and so on, except 
the parts first in order of susceptibility have been only partially cured, 
and then their recurrence may correspond with the action of those 
that are second in order of susceptibility, and all the parts will come 
into action together. What would seem to strengthen this opinion 
is, the different effects that arise from different climates: in warm 
climates the disease seldom or never rises to such a height as in cold 
climates; it is more slow in its progress, and much more easy to 
cure, at least if we may give credit to the account we have receiv- 
ed of the disease in such climates. 

Whether the difference in the time of appearance between the su- 
perficial and deeper seated parts in warm climates is the same as in 
cold ones, I do not know; but from the above theory it should not 
be so great in the warm as in the cold climates. 

Besides the causes already mentioned, it would appear that there 
are others by which the lues venerea may be brought sooner into ac- 
tion than it otherwise would be if left entirely to the nature of the 
constitution; for I think I have seen cases where fever has brought 

* See Philosophical Transactions, vol. 68, part i. page 7. 



SECT. VII. OP THE LUES VENEREA. 285 

it into action when the disposition had been previously formed. Like 
most other diseases to which there is a susceptibility or disposition, 
we find that any disturbance in the constitution shall call it forth: 
scrofula, gout, and rheumatism, are often called forth in this way. 

Having said that the deeper seated parts of the body come into ac- 
tion later than those that are superficial, I shall now observe, that 
when the lues venerea has been cured so far as only to remove the 
first actions, but not to eradicate the disposition in the deeper seated 
parts, as has been explained, under such circumstances of the dis- 
ease it never attacks again the external, or the parts that were first af- 
fected, but only the deeper seated parts, which are second in or- 
der of time. The reason is, that the deeper seated parts had not 
been affected at the time of the cure of the first. The following 
cases, selected from a great number of similar ones, will illustrate the 
doctrines we have laid down. 

In January, 1781, A. B. had connection with a woman, and two 
days after perceived an itching in the glans: at the end of four days 
he found chancres upon the prepuce. He took about twenty grains 
of calomel, and then applied to a surgeon, under whose care he re- 
mained three months, that is, till April. He thought himself nearly 
well, and went into the country, taking a few pills with him, and at 
the end of another month believed himself perfectly cured. Three 
months after, that is, in August, he caught cold, and had considera- 
ble fever, for which James's powders were given. Soon after this, 
spots of a copper colour appeared upon his legs, and he had violent 
pains in his shin bones. By the order of a country surgeon, he rub- 
bed in about an ounce of mercurial ointment, and had a slight spit- 
ting; the pain ceased, the spots disappeared, and in a month he again 
conceived himself to be well. This was in October, 1781 . In June, 
1782 he had the influenza: about a fortnight afterwards his left eye 
inflamed, and he had a pain in the head, and a noise in his ears. 
Five days afterwards his throat became sore. Three weeks alter 
the inflammation of his eye, several pustules made their appearance 
near the anus. These symptoms remained till the 21st ot August, 
when he came into St. George's Hospital. He rubbed in strong 
mercurial ointment till his mouth became sore; he sweated very 
much- the pain in his head remained, but the complaint in his eye, 
and about the anus, together with the sore throat, were totally re- 

"Tappears that, in this case, some additional power was rquired 

to dispose the body more readily to exhibit venereal symptoms 1 hat 

old has a strong power of this kind we have allowed, which appears 

h ase to have been the first immediate cause; but a lever seems 

to have been equally effectual in producing the second return of the 

Sy H P ere m was the venereal disposition in the constitution from April, 
1781, the time he was cured of the local complaint, till June, 1 RW, 



286 OF THE LUES VENEREA. CHAP. I, 

fourteen months after; and then it re-appeared eleven months after 
that, which periods might have been longer, if it had not been called 
forth by the two circumstances of cold and fever. 

Let us consider how far this case corresponds with the opinion ot 
the action being easier of cure than the disposition. The first action, 
that is, the chancres, were perfectly cured by the quantity of mercu- 
ry he took at first, for thev never recurred; but the venereal matter 
had produced the disposition in the constitution, which was not cured 
by the same quantity of mercury, for blotches appeared three months 
after; but all the parts that had* taken on the disposition at that time 
had not then come into action; therefore only the parts which had 
come into action were cured by the second course of mercury; and 
the other parts which had not yet taken on the action, went on with 
the disposition till the influenza (which happened eleven months 
after) brought them into action. The first class of pocky appearances 
were perfectly cured by the second course of mercury, as the local 
had been cured by the* first; for they never re-appeared, not even 
with the second. The second set of pocky symptoms, we have ob- 
served, appeared to be perfectly cured by the third course of mercu- 
ry. How far there may be a third set of pocky symptoms to come 
forth, time can only tell. 

This case further proves, that sometimes the second set of symp- 
toms appear first, and the first second; and also shows the difference 
in times between the first pocky appearances after the healing of the 
local, and between the second appearance of the symptoms after the 
healing of the first. 

A gentleman had a chancre in May, 1781: in the same month of 
the next year, 1782, he had a gonorrhoea; and, in May, 1783, he 
had a sore throat. He had no connection with any woman from 
September, 1782, till May, 1783, which was a fortnight before his 
throat became sore, and had had no immediate local complaints. 

When I saw the throat first, I said it was not venereal; and he, be- 
ing rather of a hectic habit, was desired to go to Bristol. When at 
Bristol, an ulcer appeared at the root of the uvula, which made him 
immediately come back to London. When T saw this ulcer I said it 
was venereal. He now went through what I supposed was a suffi- 
cient course of mercury, and all the venereal symptoms appeared to 
be cired* He went into the country about the month of August; 
and sbout the beginning of January, 1784, viz. four months after the 
supposed cure, he felt a pain, together with a swelling in his shin 
bones, for which he went through a course of mercury, which re- 
movedboth the pain and the swelling. 

In this case we have every reason to suppose that the disposition 

* I may remark here, that only the venereal ulcer got well by the mercury 
tor the former excoriation of the throat continued, but was afterwards cured bv 
bark and sarsaparilla. 



SECT. VII OF THE LUES VENEREA. 287 

had taken place in the bones, or their coverings, from the same cause 
that affected the uvula; but the uvula suffered first, being of the first 
order of parts. Whether this was really the case or not, we must al- 
low that in the parts second in order, the disposition, and notthe action, 
did exist at the time when the disease in the uvula came into action, as 
also at the time when he went through a course of mercury sufficient 
to cure the uvula; we must also allow that the disposition was not 
removed by the quantity of mercury which was capable of removing 
the disease in the uvula. From all which I would draw the follow- 
ing inferences in confirmation of the preceding doctrine: first, that the 
parts about the throat are capable of assuming the action sooner than 
the bones. Secondly, it is probable that mercury can cure the action 
only, and not the disposition; and thirdly, that the venereal pus is 
not present in the circulation while the secondary actions take place; 
for if it were, the parts first in order would stand an equal chance ol 
being again contaminated, and of coming into action a second time; 
supposing the venereal matter still to exist in the constitution alter the 
parts first thrown into action are absolutely cured, so as to contaminate 
the parts that are second in order of action, we should certainly have 
the parts first in order take on the disease a second and even a third 
time, and so on; while the second or third in order would be going 
on and only coming into their first action; and therefore we might hav e 
those that are first in order, and those that are second in order, in ac- 
tion at the same time. This might be carried still further for as it 
is possible for the parts first in order of susceptibility to have the 
disease a second time, while the parts second in order are under the 
influence of the first infection, those first in order may be contaminat- 
ed a second time from a new or fresh infection; which would be a 
lues venerea upon a lues venerea, a case which certainly may hap- 
pen. If the matter does really continue in the constitution it would 
be natural to suppose that the parts most easily affectecT by it *ould 
remain so Ions as the poison remained. It may indeed be alleged 
Smarts which have already been accustomed to this irritation and 
cured are rendered by that means less susceptible ot it 

If7he P r n were y stil. capable of circulating ^*^£ 
fects were cured, then mercury given in the ^°/ f »f^^ 
of little service as it can only assist in the cure of the chancre, out 

£££££& -nation *- ^^ft^tTy 
with exnerience; for practice informs us, that not one in imy 
would escape the lues venerea if the chancre were only cured locally; 



288 OP THE LUES VENEREA. CHAP. I. 

will take place under the course of mercury, although the parts may 
be contaminated. ^ 

This is not peculiar to the venereal disease, but common to many 
others, and in some it may be reversed; for there are diseases whose 
disposition can be cured, and therefore the action prevented, by such 
medicines as would rather increase the action if given in the time of it. 

The parts first affected are more easily cured, according to our 
method, than the parts second in order. A part once perfectly cured, 
is never irritated again by the same stock of infection, though pro- 
bably some other parts in the constitution are still under the venereal 
irritation. If the facts stated be just, the circumstance of the disease 
appearing to leave the parts first attacked, and attacking the secon- 
dary parts, is easily accounted for. It is no more than the first parts 
being cured while the secondary are not, and of course going on with 
the disease, the first remaining well. 

If this mode of accounting for these circumstances be just, it 
proves two things; first, a former assertion, that this disease, in the 
form of lues venerea, has not the power of contaminating parts, not 
already under its influence, even in the same constitution; secondly, 
that the venereal poison is not circulating in the blood all the time 
the disease is going on in the constitution; so that most probably the 
poison only irritates when just absorbed, and is soon expelled or 
thrown out in some of the secretions. 

The above account of the lues venerea may be reduced to the fol- 
lowing heads: 

First, that most parts, if not all, that are affected in the lues ve- 
nerea, are affected with the venereal irritation at the same time. 

Secondly, the parts exposed to cold are the first that admit the ve- 
nereal action; then the deeper seated parts, according to their sus- 
ceptibility for such action. 

Thirdly, the venereal disposition, when once formed in a part, 
must necessarily go on to form the venereal action. 

Fourthly, that all parts of the body, under such disposition, do not 
run into action equally fast, some requiring six or eight weeks, others 
as many months. 

Fifthly, in the parts that come first into action, the disease goes on 
increasing without wearing itself out, while those that are second in 
time follow the same course. 

Sixthly, mercury hinders a disposition from forming, or, in other 
words, prevents contamination. 

Seventhly, mercury does not destroy a disposition already formed 

Eighthly, mercury hinders the action from taking place, although 
the disposition be formed. 

Ninthly, mercury cures the action. 

These principles being established, the facts respecting the cure 
are easily accounted for. 



SECT. VII. OF THE LUES VENEREA. 



289 



Mr. Hunter having given a general summary of his doctrine, at 
the conclusion of this chapter, I shall confine myself to a few re- 
marks, in the order in which he has placed each article. 

Soon after the disease appeared in Europe it was discovered, that 
after a chancre or gonorrhoea was cured, the disease would some- 
times appear in remote parts of the body. Even when those parts 
were cured, it unhappily proved that there was no certainty fresh 
symptoms might not appear, which must be cured like the former. 
The effect of this conviction was to produce a general alarm, and 
those who had been once infected, fancied they could never after be 
free; nay, even their children were supposed to be contaminated. 
This error was not confined to the patient. Its influence on the prac- 
titioner was such, that many thought it necessary to continue the use 
of mercury for a great length of time after the first local symptoms 
Were cured, in order, as they expressed it, to eradicate the disease. 
This figurative expression, if not the cause of, probably tended to 
perpetuate an erroneous practice. Still, however, it was found, in 
spite of the most cruel and repeated salivations, that the disease 
would return. ' In the mean while they saw others who had been 
infected and were cured without difficulty, and without any return- 
ing symptom. The consequence was, that the most enlightened 
practitioners, among the rest, Boerhaave, Astruc, and Sydenham ac- 
knowledged their incapacity of confining the disease to any laws, 
whilst more superficial writers either evaded the question or boast- 
ed means of security, which no one found more successful than the 

°Twas reserved for Mr. Hunter to unravel this difficulty. By a 
patient attention to every action as it arose, and every form that it 
induced, he discovered the laws by which the disease and its remedy 
weJe governed. Not contented with this, he reduced, as we shall 
' presently see, the whole to experiment, and found a result exactly 
cor e ponding with what he had discovered from all those disjointed 
S which he had marked in the course of a long and diligent prac 

liC Like all the other laws of nature, when discovered this was found 

simple and in perfect analogy with others, as far as the phenomena 

2 but so long had the world been amused wi h figurative ex- 

Sions so much was their indolence captivated with the phantom 

of a Sse which assumed all shapes, was governed by no laws, 

and which when once introduced into the blood, could never be 
and wnicn, wi who refu§e their t 

f M*J Hunted do Sin 'still more who fancy themselves incapable 
o°f IdeSdlngt and most of all, who refuse to collect their at- 



3,1 Aw ' thai to this day there are many who refuse their assent 

^ Hunter' do Sin 'still more who fancy themselves incapable 

°f ^deSdlngt and' most of all, who refuse to collect their at- 

»R tSS^VS^X^^ 'not all, af- 
2? *2 KlS« afTected'with the venereal irritation at 



fected 

the same time 



o o 



290 OF THE LUES VENEREA- UHAP. I- 

This is proved bv those cases in which the first local symptom or 
chancre hus been cured early, vet the disease has appeared afterwards 
in the throat, skin, and bones. These are by far the most numerous 
cases, because most people apply early for relief. U a chancre has 
been attended to soon after its appearance, and in about six weeks 
after the mercurial irritation, by which it was cured, blotches ap- 
pear on the skin, if these are instantly attended to, and some months 
after they have been cured in the same way, the bones should take 
on the disease— the fair inference is, that the cause of all this mis- 
chief is to be traced to absorption, during the open state of the chan- 
cre. The matter absorbed from it in the course of its circulation 
was probably applied equally to every part, but only those parts 
which afterwards showed the disease felt the irritation, so as after- 
wards to take on the diseased action. This irritation Mr. Hunter 
called contamination. The distance of time before the diseased ac- 
tion is taken up is considerable, because all the actions in syphilis, 
or the secondary stage of the disease, are slow, and the parts are 
Concealed from our view till the diseased action has proceeded to a 
certain stage. 

2dly. Of the parts which have felt the venereal irritation, those 
which are most exposed to cold first take up the diseased action. 

3dly. The venereal disposition, when once formed in a part, must 
necessarily go on to the venereal action; or, when a part has felt the 
irritation from venereal matter, that is, when contaminated, there is 
no means of preventing its falling into the disease. To illustrate this, 
by another contagion, let us suppose ten subjects exposed to the va- 
riolous effluvia. The probability is, that all of them will inhale those 
effluvia, which will pass through the circulation of each, but only such 
as are at the time susceptible of its effects will have their skin irri- 
tated or contaminated in such a manner as, in about twelve or four- 
teen days after, to take on the disease; and we have no means of 
knowing whether the variolous irritation has taken place or not, till 
we perceive the symptoms of the disease; what is more, if we did 
know, we have no means of preventing the subsequent disease. In 
all those persons who at the end of a certain period show the disease, 
we must conclude that the same action has commenced at the time 
that the variolous effluvia passed through the circulation, and irritated 
or contaminated certain parts. The same conclusion must be drawn 
in cases of syphilis; but as no action shows itself, Mr. Hunter has 
chosen to give that state of the parts between contamination and the 
appearance of the disease, the name of a disposition to take on the 
diseased action. Without inquiring into the propriety of this term, 
it is right to remark the absolute necessity of distinguishing the two 
states of the parts in syphilis; because as in this, and in all other 
morbid poisons, when contamination has taken place, the diseased 
action will follow, so it is in vain to attempt curing the disposition, 
though we can cure the action. Thus all the severest salivations to 



SECT. VII. OF THE LUES VENEREA. 291 

prevent secondary symptoms, or lues venerea, are useless, and pro- 
bably were persevered in from the erroneous ideas of eradication. 

4thly. All parts of the body, under the disposition, do not take on 
the action at the same time. The skin and throat first; the bones or 
periosteum afterwards. 

5thly. At whatever period the diseased action commences, it gra- 
dually increases, the parts never healing spontaneously. 

6thly. Mercury hinders a disposition from forming, or prevents 
contamination. This is a fair inference, but can never be ascer- 
tained, because the primary diseased action, whether chancre or go- 
norrhoea, lias always commenced before mercury is applied. 

7thly. Mercury does not destroy a disposition already formed. 
This follows, if we admit, according to proposition the 3d, tbat, when 
the disposition is formed, or a part contaminated, nothing can pre- 
vent the diseased action from taking place. 

8ihly. Mercury hinders the diseased action from taking place, al- 
though the disposition be formed. That is, the diseased action can- 
not take [dace at the time the constitution is under the mercurial ac- 
tion; but if the disposition has been formed, the action is only sus- 
pended by mercury, and will take place as soon as the mercurial irri- 
tation has ceased. 

9thly. Mercury cures that action. 

Hence, when a part is contaminated, and under the disposition 
to the disease, which should show itself at a certain time, mercury 
will protract that period, and the disease will not show itself as long 
as the constitution is under the influence of mercury. But all this 
time the disease will not be cured. After the mercurial irritation 
has ceased, the venereal disposition which has existed ever since the 
parts were contaminated, will come into action; that is, the disease 
will appear, and in this state it may be cured. 

These principles being established, explain at once the difficulty 
that existed whilst attempts were made to eradicate the virus. 

As it was found that the disease was cured by mercury, it was 
thought that an increase of that mineral would prevent its return; 
and when it was experimentally found that no increase would pre- 
vent its appearance in a distant part, the only inference drawn was, 
that when once the poison had entered the blood it was scarcely 
possible to eradicate it. 

The case of A. B. [p. 285,] is not only very much confused, but it 
is to be remarked, that Mr. Hunter could only have seen the patient 
after he was received into St. George's hospital. All the symptoms 
described at that period are somewhat uncertain; those about the 
anus, we are informed, may arise from other causes, [p. 298.] The 
same is remarked of inflammation in the eye, [p. 301,] even when 
it has yielded to mercury. The pain in the head was not cured by 
tbe mercurial course. The only remaining symptom is the throat. 
This, though included in the same order as the skin, may sometimes 



292 OP THE LUES VENEREA. CHAP. I. 

form a subdivision of that order, and the one may be cured, after 
which the disease may appear in the other. But this is, I believe, 
very uncommon, for If the disease appears in the skin and throat, 
both are usually affected so nearly at the same time as to be cured 
together. On the whole, it may be determined that a case of so 
many anomalies, and the greater part of which is so ill authenti- 
cated, cannot be admitted as an illustration till supported by others; 
and that a solitary instance of this kind should have found a place 
in the work, can only be accounted for by the readiness of Mr. Hun- 
ter to make every possible concession to long received opinions. 

I cannot conclude this part of the subject, without relating the 
substance of a conversation I had the happiness of enjoying with 
Mr. Hunter, a very few days before he died. At the close of the 
first edition of " Morbid Poisons," this conversation is alluded to as 
the circumstance which gave rise to that publication. 

I waited on him to propose preparing for the public an explanation 
of his doctrine, contained in the Treatise on the Venereal Disease. 
Those who knew Mr. Hunter well, know how fond he was of con- 
versing on pathological subjects with such as took pains to follow 
his mode of induction. They will therefore not wonder, if, on this 
occasion, our conversation was more protracted than his numerous 
engagements might seem to permit. I remarked to him how ill he 
was understood, and the probability that he might be best explained 
by answering those who had objected to his doctrines. He was much 
pleased with the proposal, and informed me that he had recommended 
the undertaking to one who understood him very well, but did not 
seem quite ready at that kind of writing. " It is surprising," said 
I, " how few people understand your distinction between Disposi- 
tion and Action, and that a remedy which will cure one will not 
cure the other." " It surprises me daily," said he, " and most of 
all, that Mr. Moore should have misunderstood me so much." " Pro- 
bably," said I, " it may be the simplicity of your doctrine that 
makes others overlook it, whilst they arc endeavouring to unravel a 
mystery." " It may be so," said he, " for I had lately an opportu- 
nity of seeing how easily it might be comprehended, even by one 
who is altogether unaccustomed to such inquiries. 

" A gentleman," continued he, " who had been cured of a chan- 
cre at a distance from home, called to consult me whether he might 
consider himself as perfectly free from the disease. Whilst he was 
taking great pains to explain to me how he had been salivated, and 
how long he had continued the use of mercury after the chancre was 
healed, I interrupted him, by observing, that if he had continued the. 
use of mercury till now, I could not pretend to say whether he was 
free from the disease. ' How then,' said the gentleman, ' am I to 
ascertain my real situation?' ' If,' replied I, ' you find no symp- 
toms in the course of three months, the probability is, that you will 
remain well till you expose yourself to a new source of infection,' 



CHAP. II. OP THE LUES VENEREA. 293 

" In about six weeks he returned with a sore throat and copper 
spots. I explained to him, that he should not blame his surgeon, who, 
even if he had known what was to happen, could not have prevented 
it. The patient went through a necessary course of mercury, till 
he was cured of every symptom; and then demanded, with some im- 
patience, whether he was then secure. ' You are secure,' replied I, 
' from every return on the genitals, and on your skin and throat; but 
as it is impossible for me to know whether your bones are contami- 
nated, I cannot pretend to say whether you will have nodes in a few 
weeks time.' He now began to comprehend the doctrine, and sub- 
mitted to await the result. In about six weeks he actually had nodes; 
after the cure of which, by a severe salivation, I made no scruple to 
assure him, that he was perfectly free from the disease." 

I have transcribed this conversation, as an epitome of one part of 
Mr. Hunter's doctrine, and also to show that his increased experi- 
ence confirmed his conviction of what he had written and taught. 



CHAP. II. 

Of the Symptoms of the Lues Venerea. 

When the ve^ ereal matter has affected the constitution in any of 
the ways before mentioned, it has the whole body to work upon, and 
shows itself in a variety of shapes; many of which putting on the 
appearance of a different disease, we are often obliged to have re- 
course to the preceding history of the case, before we can form any 
judgment of it. Probably the varieties in the appearances may be 
referred to the three following circumstances: the different kinds of 
constitutions; the different kinds of solids affected; and the difler- 
cnt dispositions which the solids are in at the time: for I can easily 
conceive, that a peculiarity of constitution may make a very mate- 
rial difference in the appearance of the same specific complaint; and 
I am certain, that the solids, according to their different natures, pro- 
duce a verv different appearance when attacked with this disease; 
and I can "only easily conceive that a different disposition from the 
common, in the solids at the time, may make a considerable ditter- 
ence in the appearances. ,. ffapiiBf 

The difference of constitution, and of the same parts at different 
times may have considerable effects in the disease with respect to 
rpp arL sooner or later. This I am certain of that the differ- 
ent parts of the bodv produce a very considerable difference in 
the tim of appearance of this disease. That it appears much 



Jii-4- OF THE LUES VENEREA. CHAP. II. 

sooner in some parts than in others is best seen where different parts 
are affected in the same person; for I have already endeavoured to 
show that it is most probable that all the parts affected are contami- 
nated nearly at the same time. This difference in the times is either 
owing to some parts being naturally put into action more easily by 
the poison than others, or they are naturally more active in them- 
selves, and therefore probably will admit more quickly the action of 
every disease that is capable of affecting them. 

When on the general history of the lues venerea, I divided the 
parts into two orders, according to the time of their appearance; I 
also observed that the first were commonly the external parts, as the 
skin, nose, tonsils; and that the second were more internal, as the 
bones, periosteum, fascise, and tendons. 

The time necessary for its appearance, or for producing its local 
effects in the several parts of the body most readily affected, after it 
has got into the constitution, is uncertain; but in general it is about 
six weeks; in many cases, however, it is much later, and in others 
much sooner. In some cases it appears to produce its local effects 
within a fortnight after the possibility of the absorption of the mat- 
ter. In one case a gentleman had a chancre, and a swelling in the 
groin came on, and within the before-mentioned time he had vene- 
real eruptions all over the body. He could not impute this to any 
former complaint, yet there is a possibility of its having arisen from 
the first mode of catching the disease, by simple contact, at the time 
he got the local or chancre, which might extend the time to a week 
or more, although this is not probable. In another case, three weeks 
after the healing of the chancre, eruptions broke out all over the 
body, and this happened only a fortnight after leaving off the course 
of mercury that cured the chancre. The effects on other parts of 
the body that are less susceptible of this irritation, or are slower in 
their action, are of course much later in appearing; and in those 
cases where both orders of parts are contaminated, it is in general 
not till after the first has made its appearance for a considerable 
time, and even perhaps after it has been cured; for while the parts 
first in order of action were contaminated and under cure, the se- 
cond in order are only in a state of contamination; and go on with 
the disease afterwards, although it may never again appear in the 
first. 

From this circumstance of the parts second in order coming later 
into action, we can plainly see the reason why it shall appear in 
them, although the first in order may have been cured; for if the ex- 
ternal parts, or first in order, have been cured, and the internal, or 
second, such as the tendons, bones, periosteum, &c. have not been 
cured, then it becomes confined solely to these parts. The order of 
parts may sometimes be inverted; for I have seen cases where the 
periosteum, or bone, was affected prior to any other part; whether in 
the same case it might in the end have affected the skin, or throat, I 



CHAP. II. OF THE LUES VENEREA. "i!)j 

will not pretend to say, as it was not allowed to go on; but it is pos- 
sible that the second order of parts may be affected without the first 
having ever been contaminated. 

Its effects on the deeper seated parts are not like those produced 
in the external, and the difference is so remarkable as to give the 
appearance of another disease; and a person accustomed to see it 
in the first parts only, would be entirely at a loss about the second. 

The parts which come first into action go on with it, probably on 
the same principle, much quicker than the others; and this arises 
from the nature of the parts, as has already been observed. 

Each succeeding part, that becomes affected, is slower and slower 
in its progress, and more fixed in its symptoms when produced; this 
arises also from the natural disposition of such parts, all their actions 
being slow, which indolent action may be assisted by the absence of 
the great disposing cause, that is, cold. I should, however, suspect 
that warmth does not contribute much to their indolence of action; 
for if it did, it would assist in the cure, which it appears not to do, 
these parts being as slow in their operations of restoration as they 
are in their actions of disease. We may also observe, that similar 
parts come sooner into action, and appear to go on more rapidly with 
it, as they are nearer the source of the circulation. It appears ear- 
lier on the face, head, shoulders, and breast, than on the legs, and 
the eruptions come sooner to suppuration in the before-mentioned 

parts.* 

The circumstance of its being very late in appearing in some 
parts, when it had been only cured in its first appearances, as mi n- 
tioned, has made many suppose that the poison lurked somewhere in 
the solids; and others, that it kept circulating in the blood for 

years. , 

It is not, however, easy to determine this point; but there can be 
no good reason for the first hypothesis, as the lurking disposition ne- 
ver takes place prior to its first appearance; for instance, we never 
find that a man had a chancre a twelvemonth ago, and that it broke 
out after in venereal scurfs, upon the skin, or ulcers in the throat. 
The slowness of its progress is only when the parts less susceptible 
of its irritation have been affected by it. 

In the previous chapter we have a minute detail of the doctrine. 
This section contains an illustration of it by those phenomena in the 
history of the disease, which, though perpetually occurring, were riot 
only not understood, but never regularly traced, before our author de- 
tected them. The passage, like many others, is encumbered more 
than is necessary by a perpetual reference to objections which may 
be raised against the doctrine, and by allusions to the original struc- 

- Sec Introduction. 



296 OF THE LUES VENEREA. CHAP. II. 

ture of parts, the accidental situation in which they may be placed, 
or the peculiarities of constitution which may influence them. All 
these it might be expected that Mr. Hunter would not overlook; but 
it is much to be regretted that he did not keep them apart, to be con- 
sidered by themselves as deviations from the usual course. By con- 
ceiving it his duty to meet them on all occasions, the attention of the 
reader is unnecessarily distracted, so as with difficulty to retain the 
scries of actions which are to be considered as forming the laws of 
the disease. Let us see how they may be disposed in the order sug- 
gested. 

The venereal matter, being absorbed and affecting the constitu- 
tion, induces certain actions in different parts, according to the na- 
ture of those parts, and to the circumstances in which they may 
happen to be placed. The slowness of these actions makes them 
the more liable to be interrupted by various others which may be 
going on in the constitution or parts, and renders it difficult to ascer- 
tain them till they arc completely formed. We should therefore be 
cautious of giving an opinion without a minute inquiry into every 
part of the previous history as well as an examination of all the pre- 
sent symptoms, attending to the precise period of every event which has 
occurred throughout, comparing them with the periods at which such 
events occur in the usual progress of the disease, marking any devia- 
tion, and seeing how far it may be accounted for, or registering each 
for our future information. 

We must always keep in view, however, that the subject on which 
our inquiries are made is a living body, and in the whole race of 
animals of the same class \xt see so much variety of constitution, 
that we cannot wonder if this variety affects the changes which is 
produced by disease. Yet in both there are certain actions which 
are so uniform in the whole, that they may be considered as laws; 
and, whenever we suspect any deviation from them, we should trace 
them with the utmost minuteness, and record them with equal 
fidelity. 

We are not to consider the different forms and periods at which 
different parts of the same body are affected by the same poison, as 
among these anomalies. They may probably be accounted for from 
the very structure of the parts, their accidental exposure to heat or 
cold, and the slow manner in which all the actions of some of them 
are carried on; but, independently of this, there is such an uniform- 
ity in this respect in most constitutions, that they may be consi- 
dered as laws. The usual progress of the disease is for the soft 
parts to be first affected, and the bones with their appendages after- 
wards, yet it cannot be considered as any deviation from the law, if 
the only secondary symptoms we meet with should be in the bones; 
because we never can ascertain whether any other parts were conta- 
minated, when the poison was circulating. 

Such is the general drift of this passage, the whole of which. 



SECT I 

OF THE LUES VENEREA. 297 

being only introductory to a more minute account of the symptoms 
might verj well hav€ been omitted. Indeed, the last paragraph is 
absolutely unintelligible, and its insertion can only be accounted for 
by the circumstances which attended the preparation of the book for 
the public, as mentioned in the commentator's preface. 



SECTION I. 

Of the Symptoms of the first Stage of the Lues Venerea. 

The first symptoms of the disease, after absorption, appear either 
f on the skin, throat, or mouth. These differ from one another accord- 
ing to the nature of the parts affected. I shall therefore divide them 
into two kinds, although there appears to be no difference in the na- 
ture of the disease itself. 

The appearance on the skin I shall call the first, although it is not 
always the first appearance; for that in the throat is often as early a 
symptom as any. The appearances upon the skin generally show 
themselves in every part of the body, no part being more susceptible 
than another, first in discolorations, making the skin appear mottled, 
many of them disappearing, while others continue, and increase with 
the disease."' 

In others it will come on in distinct blotches, often not observed 
till scurfs are forming; at other times they appear in small distinct in- 
flammations, containing matter and resembling pimples, but not so 
pyramidal, nor so red at the base. 

Venereal blotches, at their first coming out, are often attended with 
inflammation, which gives them a degree of transparency, which I 
think is generally greater in the summer than in the winter, especially 
if the patient be kept warm. In a little time this inflammation dis- 
appears, and the cuticle peals off in the form of a scurf. This some- 
times misleads the patient and the surgeon, who look upon this dying 
away of the inflammation as a decay of the disease, till a succession 
of scurfs undeceives them. 

These discolorations of the cuticle arise from the venereal irrita- 
tion, and are seldom to be reckoned a true inflammation, for they sel- 
dom have any of its characteristics, such as tumefaction and pain; 
but this is true only on those parts most exposed; for in parts well 
covered, and in parts constantly in contact with other parts, there 
is more' of the true inflammatory appearance, especially about the 
anus. 

* This is not peculiar to this disease, it often takes place in the small-pox. 

P P 



298 OF THE LUES VENEREA. CHAP. II. 

The appearance of the parts themselves next begins to alter, form- 
ing a copper-coloured, dry, inelastic cuticle, called a scurf; this is 
thrown off, and new ones are formed. These appearances spread to 
the breadth of a sixpence or shilling, but seldom broader, at least for 
a considerable time, every succeeding scurf becoming thicker and 
thicker, till at last it becomes a common scab, and the disposition for 
the formation of matter takes place in the cutis under the scab, so that 
at last it turns out a true ulcer; in which state it commonly spreads, 
although but slowly. 

These appearances arise from the gradual loss of the true sound 
cuticle; the diseased cutis having lost the disposition to form one; 
and, as a kind of substitute for this want of cuticle, an exudation 
takes place, forming a scale, and afterwards becoming thicker, and 
the matter acquiring mote consistence, it at last forms a scab; but 
before it has arrived at this stage, the cutis has given way, and ulcer- 
ated, after which the discharge becomes more of a true pus. When 
it attacks the palms of the hands and the soles of the fett, where the 
cuticle is thick, a separation of the cuticle takes place, and it peels 
off, a new one is immediately formed, which also separates, so that a 
series of new cuticles takes place from its not so readily forming scurfs 
as on the common skin. If the disease is confined to those parts, it 
becomes more difficult to determine whether or not it be venereal; 
for most diseases of the cutis of these parts produce a separation of 
the cuticle, attended with the same appearances in all, and having 
nothing characteristic of the venereal disease. 

Such appearances are peculiar to that part of the common skin of 
the body which is usually exposed; but when the skin is opposed by 
another skin which keeps it in some degree more moist, as between 
the nates, about the anus, or between the scrotum and the thigh, or in 
the angle between the two thighs, or upon the prolabium of the 
mouth, and in the arm-pits, the eruptions never acquire the above- 
described appearances, and instead of scurfs and scabs we have the 
skin elevated, or, as it were, tumefied by the extravasated lymph 
into a white, soft, moist, flat surface, which discharges a white' mat- 
ter. This may perhaps arise from there being more warmth, more 
perspiration, and less evaporation, as well as from the skin bein° 
thinner in such places. What strengthens this idea still more is~, 
that in many venereal patients I have seen an approach towards such 
appearances on the common skin of the body; but this has been on 
such parts as were covered with the clothes; 'for on those parts of the 
skin that were not covered, there was only the flat scurf: these, how- 
ever, were redder than the above-described appearances, but hardly 
so high. 

How far this is peculiar to the venereal disease, I know not. It 
may take place in most scurfy eruptions of the skin. From a sup- 
position of this not being venereal, I have destroyed them at the side 
Vf the anus with a caustic, and the patient has got well; however from 



SECT - '• OP THE LUES VENEREA. 299 

my idea of the disease, that every effect from the constitution is truly 
local, and therefore may be cured locally, a cure effected by this 
treatment does not determine the question. 

This disease, on its first appearance, often attacks that part of the 
fingers upon which the nail is formed, making that surface red which 
is seen shining through the nail; and, if allowed to continue, a sepa- 
ration of the nail takes place, similar to the cuticle in the before-de- 
scribed symptoms; but here there cannot be that regular succession of 
nails as there is of cuticle. 

It also attacks the superficies of the body which is covered with 
hair, producing a separation of the hair. A prevention of the 
growth of young hair is also the consequence while the disease 
lasts. 

The second part in which it appears is most commonly the throat, 
sometimes the mouth and tongue. In the throat, tonsils, and inside 
of the mouth, the disease generally shows itself at once in the form of 
an ulcer without much previous tumefaction, so that the tonsils are 
not much enlarged; for when the venereal inflammation attacks these 
parts, it appears to be always upon the surface, and it very soon ter- 
minates in an ulcer. 

These ulcers in the throat are to be carefully distinguished from 
all others of the same parts. It is to be remarked, that this disease, 
when it attacks, always, I believe, produces an ulcer; although this 
is not commonly understood; for I have seen cases where no ulcera- 
tion had taken place, called, by mistake, venereal. It is therefore only 
this ulcer that is to be distinguished from other ulcers of these parts. 
This species of ulcer is generally tolerably well marked, yet it is per- 
haps in all cases not to be distinguished from others that attack this 
part, for some have the appearance of being venereal, and what are 
really venereal resemble those that are not. We have several dis- 
eases of this part which do not produce ulceration on the surface, one 
of which is common inflammation of the tonsils, which often suppu- 
rates in the centre, forming an abscess, which bursts by a small open- 
ing, but never looks like an ulcer begun upon the surface, as in the 
true venereal: this case is always attended with too much in- 
flammation, pain, and tumefaction of the parts to be venereal; and 
if it suppurates and bursts, it subsides directly, and it is gene- 
rally attended with other inflammatory symptoms in the consti- 
tution. . " . 

There is another disease of these parts, which is, an indolent 
tumefaction of the tonsils, and is peculiar to many people whose 
constitutions have something of the scrofula in them, producing a 
thickness in the speech. Sometimes the coagulable lymph is thrown 
out on the surface, and called by some ulcers, by others sloughs, and 
such are often called putrid sore throats. Those commonly swell to 
too lar^c a size for the venereal; and this appearance is easily dis- 
tinguished from an ulcer or loss of substance; however, where it is 



300 OE THE J.UES VENEREA. CHAV- II* 

not plain at first sight, it will be right to endeavour to remove some 
of it; and if the surface of the tonsil is not ulcerated, then we may be 
sure it is not venereal. I have seen a chink filled Avith this appear- 
ing very much like an ulcer; but upon removing the coagulable 
lymph,* the tonsil has appeared perfectly sound. I have seen 
cases of a swelled tonsil where a slough formed in its centre, and 
that slough has opened- a passage out for itself; and when it has 
been as it were sticking in this passage, it has appeared like a 
foul ulcer. 

The most puzzling stage of the complaint is when the slough is 
come out, for then it has most of the characters of the venereal ulcer; 
but when I have seen the disease in its first stages, I have always 
treated it as of the erysipelatous kind, or as something of the nature 
of a carbuncle. 

When I have seen them in their second stage only I have been apt 
to suppose thera venereal; however, no man will be so rash as to 
pronounce w-1 a; a disease is from the eye only, but will make in- 
quiries into all the circumstances before he forms a judgment. If 
there have been no preceding local symptoms within the proper date, 
he will suspend his judgment, and wait a little to see how far nature 
is able to relieve herself. If there has been any preceding fever, it 
will be still less probable that it is venereal. However, I will not 
say of what nature such cases are, but only that they are not venereal, 
as they are often believed to be. I have seen a sore throat of this kind 
mistaken for venereal, and mercury given till it affected the mouth, 
which, when it did, it brought on a mortification on all the parts con- 
cerned in the first disease. It would therefore appear that this species 
of the sore throat is aggravated by mercury. 

There is another complaint of those parts which is often taken for 
venereal, which is, an ulcerous excoriation, where the ulceration or 
excoriations run along the surface of the parts, becoming very broad 
and sometimes foul, having a regular termination, but never going 
deep into the substance of the parts as the venereal ulcer does. 
There is no part of the inside of the mouth exempted from this 
ulcerous excoriation; but I think it is most frequent about the root 
of the uvula, and spreads forwards along the palatum molle. That 
such are not venereal is evident from their not giving way in 
general to mercury; and I have seen them continue for weeks with- 
out altering, and a true venereal ulcer appear upon the centre of the 
excoriated part. 

The difference between the two is so strong that there can be no 
mistake; patients have gone through a course of mercury which has 
perfectly cured the venereal ulcers, but has had no effect upon the 
others, which have afterwards been cured by bark. 

The true venereal ulcer in the throat is perhaps the least liable to 
be mistaken of any of the forms of the disease. It is a fair loss of 
substance, part being dug out as it were from the body of the 



SECT - r - OF THE LUES VENEREA. 301 

tonsil, with a determined edge, and is commonly very foul, hav- 
ing thick white matter adhering to it like a slough, which cannot be 
nrashed away. 

Ulcers in such situations are always kept moist, the matter no! 
being allowed to dry and form scabs, as in those upon the skin; 
the matter is carried off the ulcers by deglutition, or the motion of 
the parts, so that no succession of scurfs or scabs can take place, as 
on the skin. 

Their progress is also much more rapid than on the common skin, 
ulceration taking place very fast. 

Like most other spreading ulcers, they are generally very foul, 
and for the most part have thickened or bordered edges, which 
is very common to venereal or cancerous sores, and indeed to 
most sores which have no disposition to heal, whatever the specific 
disease may be. 

When it attacks the tongue it sometimes produces a thickening 
and hardness in the part; but this is not always the case, for it very 
often ulcerates as in the other parts of the mouth. 

They are generally more painful than those of the skin; al- 
though not so much so as common sore throats arising from in- 
flamed tonsils. 

They oblige the person to speak thick, or as if his tongue was too 
large for his mouth, with a small degree of snuffling. 

These arc the most common symptoms of this stage of the disease; 
but it is perhaps impossible to know all the symptoms this poison 
produces when in the constitution. I knew a gentleman who had a 
teasing cough, which he imputed to it; for it came on with the symp- 
tomatic fever and continued with it, and by using mercury both dis- 
appeared. 

There are inflammations of the eyes which are supposed to be ve- 
nereal; for after the usual remedies against inflammation have been 
tried in vain, mercury has been given on the supposition of the case 
being venereal, and sometimes with success, which has tended to 
establish this opinion. But if such cases are venereal, the disease is 
very different from what it is when attacking other parts, from the 
constitution, for the inflammation is more painful than in venereal 
inflammation proceeding from the constitution; and I have never 
seen such cases attended with ulceration, as in the mouth, throat, 
and tongue, which makes me doubt much of their being venereal. 



All these symptoms are described with so much accuracy and mi- 
nuteness, that nothing can be added to them. It may, however, be 
right to caution the reader against a mistaken interpretation of that 
part of the text to which the note refers. Dr. Cluttcrbuck has 
brought this passage as a proof that Mr. Hunter admits venereal 
blotches will cure themselves without the use of any remedy. But, 



3QJ OF THE LUES VENEREA. CHAP. II. 

on a second examination, that gentleman will see that the symptom 
here noticed is the erythema, which precedes eruptions from many 
other morbid poisons, and not the true disease. The illustration of 
small-pox is sufficient to show this, and the same happening still more 
frequently in cow-pox proves, that the discoloration is not the disease 
itself, but an erythema, which arises from the constitution feeling an 
irritation that produces this temporary effect on the skin. The sub- 
sequent section, containing the author's experiments, is peculiarly in- 
teresting, 



SECTION II. 

Experiments mude io ascertain the Progress and Effects of the Vene- 
real Poison. 

To ascertain several facts relative to the venereal disease, the fol- 
lowing experiments were made. They were begun in May, 1767. 

Two punctures were made on the penis with a lancet dipped in ve- 
nereal matter from a gonorrhoea; one puncture was on the glans, the 
other on the prepuce. 

This was on a Friday; on the Sunday following there was a teasing 
itching in those parts, which lasted till the Tuesday following. In 
the mean time, these parts being often examined, there seemed to be 
a greater redness and moisture than usual, which was imputed to the 
parts being rubbed. Upon the Tuesday morning, the parts of the 
prepuce where the puncture had been made were redder, thickened,, 
and had formed a speck; by the Tuesday following, the speck had 
increased and discharged some matter, and there seemed to be a lit- 
tle pouting of the lips of the urethra, also a sensation in it in making 
water, so that a discharge was expected from it. The speck was now 
touched with lunar caustic, and afterwards dressed with calomel 
ointment. On Saturday morning, the slough came off; and was 
again touched, and another slough came off on the Monday follow- 
ing. The preceding night the glans had itched a good deal, and on 
Tuesday a white speck was observed where the puncture had been 
made; this speck, when examined, was found to be a pimple full of 
yellowish matter. This was now touched with the caustic, and 
dressed as the former. On the Wednesday, the sore on the prepuce 
xvas yellow, and therefore was again touched with caustic. On the 
Friday both sloughs came off; and the sore on the prepuce looked 
red, and its basis not so hard; but on the Saturday it did not look- 
quite so well, and was touched again; and, when that went off, it 
was allowed to heal, as also the other, which left a dent in the slans. 



SECT - lr - OF THE LUES VENEREA. 303 

This dent on the glans was filled up in some months, hut for a con- 
siderable time it had a bluish cast. 

Four months afterwards the chancre on the prepuce broke out 
again; and very stimulating applications were tried; but these seem- 
ed not to agree with it, and nothing being applied, it healed up. 
This it did several times afterwards, but always healed up without 
any application to it. That on the glans never did break out; and 
herein also it differed from the other. 

While the sores remained on the prepuce and glans, a swelling 
took place in one of the glands of the right groin. I had for some 
time conceived an idea that the most effectual way to put back a bu- 
bo was to rub in mercury on that leg and thigh, that thus a current 
bf mercury would pass through the inflamed gland. There was 
a good opportunity of making the experiment. I had often succeed- 
ed in this way, but now wanted to put it more critically to the test* 
The sores upon the penis were healed before the reduction of the 
bubo was attempted. A few days after beginning the mercury in 
this method the gland subsided considerably. In was then let off; 
for the intention was not to cure it completely at present. The gland 
some time after began to swell again, and as much mercury was 
rubbed in as appeared to be sufficient for the entire reduction of the 
gland; but it was meant to do no more than to cure the gland local- 
ly, without giving enough to prevent the constitution from being con- 
taminated. 

About two months after the last attack of the bubo, a little sharp 
pricking pain was felt in one of the tonsils in swallowing any thing; 
and, on inspection, a small ulcer was found, which was allowed to go 
on till the nature of it was ascertained, and then recourse was had to 
mercury. The mercury was thrown in by the same leg and thigh 
as before, to secure the gland more effectually, although that was not 
now probably necessary. 

As soon as the ulcer was skinned over, the mercury was left off, 
it not being intended to destroy the poison, but to observe what parts 
it would next affect. About three months after, copper-coloured 
blotches broke out on the skin, and the former ulcer returned in the 
tonsil. Mercury was now applied the second time for those effects 
of the poison from the constitution, but still only with a view to 

palliate. . 

It was left off a second time, and the attention was given to mark- 
where it would break out next; but it returned again in the same 
parts. It not appearing that any further knowledge was to be pro- 
cured bv only palliating the disease a fourth time in the tonsil, and a 
third time in the skin, mercury was now taken in a sufficient quan- 
tity, and for a proper time, to complete the cure. ' 

* The practice in 1767 was, to apply a mercurial plaster oil the part, or to 
rub in mercurial ointment on the part, which could hardly act by any other 
power than sympathy. 



304 . OF THE LUES VENEREA. CHAP. II. 

The time the experiments took up, from the first insertion to the 
complete cure, was about three years. 

The above case is only uncommon in the mode of contracting the 
disease, and the particular views with which some parts of the treat- 
ment were directed; but, as it was meant to prove many things, 
which, though not uncommon, are yet not attended to, attention was 
paid to all the circumstances. It proves many things, and opens a 
field for further conjectures. 

It proves, first, that matter from a gonorrhoea will produce chancres. 

It makes it probable that the glans does not admit the venereal 
irritation so quickly as the prepuce. The chancre on the prepuce 
inflamed and suppurated in somewhat more than three days, and that 
on the glans in about ten. This is probably the reason why the glans 
did not throw off its sloughs so soon. 

It renders it highly probable, that to apply mercury to the legs and 
thighs is the best method of resolving a bubo; and therefore also the 
best method of applying mercury to assist in the cure, even when the 
bubo suppurates. 

It also shows that buboes may be resolved in this way, and yet the 
constitution not safe; and therefore that more mercury should be 
thrown in,"especially in cases of easy resolution, than what simply 
resolves the bubo. 

It shows that parts may be contaminated, and may have the poison 
kept dormant in them, while under a course of mercury for other 
symptoms, but break out afterwards. 

It also shows that the poison, having originally only contaminated 
certain parts, when not completely cured, can break out again only 
in those parts. 



SECTION III. 

Of the Symptoms of the Second Stage of the Lues Venerea. 

This stage of the disease is not so well marked as the former; and, 
as it is of more importance, it requires all our discernment to deter- 
mine what the disease is. 

The parts less susceptible of this irritation are such as are more 
out of th^way of the great exciting cause, which is, the external air 
as has been before related. And they begin to take on the venereal 
action whether it may or it may not have produced its local effects 
upon the external or exposed surfaces; and they even go on with the 
action, in many cases, after these surfaces first affected have taken on 
the action, and have been cured, as has been already observed 



9£ CT. III. OF THE LUES VENEREA. 305 

These deeper seated parts are, the periosteum, tendons, fascia?, and 
ligaments; however, what the parts affected may be when the- dis- 
ease is in this stage is not always certain; I have known it pro- 
duce total deafness, and some of those cases to end in suppuration, 
attended with great pain in the ear and side of the head. Such 
cases are generally supposed to arise from some oilier cause; and 
nothing but some particular circumstance in the history of the ease, 
or some symptom attending it, can lead the surgeon to the nature of 
the complaint. 

When these deeper seated parts become irritated by this poison, 
the progress is more gradual than in the first; they have very much 
the character of scrofulous swellings, or chronic rheumatism, oniy in 
this disease the joints are not so subject to it as they are in the rheu- 
matism. We shall find a swelling come upon a bone when there 
has been no possible means of calching the infection For many 
months, and it will be of some size before it is taken notice of, from 
having given but little pain. On the other hand, there shall be 
great pain, and probably no swelling to be observed till some time 
after. The same observations are applicable to the swelling of ten- 
dons and fasciae. 

As these swellings increase by slow degrees, they shew but little 
signs of inflammation. When they attack the periosteum, the swell- 
ing has all the appearance of a swelling of the bone, by being firm 
and closely connected with it. 

The inflammation, produced in these later stages of the disease, 
can hardly get beyond the adhesive, in which state it continues grow- 
ing worse and worse, and when matter is formed it is not true pus, 
but a slimy matter. This may arise in some degree from the nature 
of the parts not being in themselves easily made to suppurate; and, 
when they do suppurate, the same languidness still continues, inso- 
much that this matter is not capable of giving the extraneous stimu- 
lus, so as to excite true suppuration or ulceration, even alter the con- 
stitution is cleared of the original cause, and then the disease is pro- 
bably scrofulous. Some nodes, either in the tendons or bones, last 
for years before they form any matter at all; and in this case 
it is doubtful whether they are venereal or not, although commonly 
supposed to be so. . . ,. 

I have already observed that the pain in the first stages of this dis- 
ease is much less than might be expected, considering the effects pro- 
duced by the poison. The disease being very slow and gradual m 
its progress, its giving little pain may be accounted for. An ulcer ,n 
the throat causes no great pain; and the same may be said of blotches 
on the skin, even whin they become large sores. 

When the periosteum and bones become affected, the pain is some- 
times verv considerable, and at other times there is hardly any. It 
Tot Sal easy to' account for this. We know also that he 
tendinous parts! when inflamed, give in some cases very considerable 



306 OF THE LUES VENEREA- CHAP. II. 

pain, and that of the heavy kind, while in others they will swell con- 
siderably without giving any pain. 

These pains are commonly periodical, or have their exacerbations, 
being commonly worst in the night. This is common to other aches 
or pains, especially of the rheumatic kind, which the venereal pains 
resemble very much. 

When the pain is the first symptom, it affords no distinguishing 
mark of the disease, it is therefore often taken for the rheumatism. 
/ 

In the previous sections having shewn the progress of the seconda- 
ry symptoms, in the first order of parts, that is, in the softer and 
and more sanguiferous parts, Mr. Hunter proceeds now to trace them 
in the second order, that is, the bones, periosteum, fascia?, and liga- 
ments. This section is not less complete than the former, and re- 
quires no illustration. The same may be said of the succeeding sec- 
tion on the constitutional symptoms, which contains a most accurate 
illustration of the hectic fever, mentioned in the introduction. 

The fissures alluded to by Mr. Hunter, by some authors called 
Rhagades, are very common in warm climates, at the ends of the 
fingers and edges of the hand in such whose skin is particularly dry. 
By some writers they are called leprous, by others venereal, but they 
seem unconnected with either disease: at least in all the subjects in 
whom I saw them, there was no grounds to suspect either. The ap- 
pearance was constantly attended with a particular dry skin and with 
an occasional burning heat in the extremities. 



SECTION IV. 

Of the Effects of the Poison on the Constitution. 

The poisonous matter, simply as extraneous matter, produces no 
change whatever upon the constitution, and whatever effects it has 
depend wholly upon its specific quality as a poison. The general 
effects of this poison on the constitution are similar to other irrita- 
tions, either local or constitutional. It produces fever, which is 
of the slow kind; and when it continues a considerable time, it 
produces what is called a hectic disposition, which is no more 
than an habitual slow fever arising from a cause which the con- 
stitu ion cannot overcome. While this exists, it is impossible that 
anything salutary can go on in such a constitution. The patient 



SECT - IV ' OP THE LUES VENEREA. 307 

loses his appetite, or even if his appetite is good, loses his flesh 
becomes restless, loses his sleep, and looks sallow* 

in the hist stage of this disease, before it begins to show itself ex- 
ternally, the patient has generally rigors, hot lits, headachs, and 
all the symptoms of an approaching fever. 

These symptoms continuing for some days, and often for weeks 
show that there is some irritating cause which works slowly upon 
the constitution. It is then supposed to be whatever the invention 
or ingenuity of the practitioner shall call it; but the venereal erup- 
tions or nodes upon either the periosteum, bones, tendons, or other 
parts, appearing, show the cause, and in some degree carry off the 
symptoms of fever and relieve the constitution for a little time but 
they soon recur. 

These constitutional complaints, however, are not always to be 
found; the poison stimulating so slowly as hardly to affect the consti- 
tution, unless it be allowed to remain in it a long time. 

There are a number of local appearances, mentioned by authors, 
which I never saw, such as the fissures about the anus, &c. There 
are also a number of diseases, described by authors as venereal, 
especially by Astruc and his followers, which arc almost endless! 
The cancer, scrofula, rheumatism, and gout, have been considered as 
arising from it, which may be in some measure true; but they are 
with them the disease itself, and all their consequences, as consump- 
tion, wasting from want of nourishment, jaundice, and a thousand 
other diseases, which happened many years before the existence of 
the lues venerea, are all attributed to it. 

There is even at this day hardly any disease the practitioner is 
puzzled about, but the venereal comes immediately into his mind ; 
and if this became the cause of careful investigation, it would be 
productive of good, but with many the idea alone satisfies the mind. 



CHAP. III. 



General Observations on the Cure of the Lues Venerea. 

It has been observed before, that there are three forms of the ve- 
nereal infection, gonorrhoea, chancre, and the lues venerea, which 
various forms I have endeavoured to account for. As they all three 
arise from the same poison, and as the two first depend only on a 

* This kind of look, although arising entirely from a harrascd constitution, is 
always supposed to be peculiar to a venereal one. This idea, however, does not 
arise from the look only, but from the leading symptoms. 



308 OF THE LUES VENEREA. CHAP- III- 

difference in the nature of the parts, and the lues venerea on another 
circumstance which has been explained, it would be natural to sup- 
pose that one medicine, whatever it be, would cure all the forms of 
this disease. But wt find from experience that this does not hold good; 
for one medicine, that is, mercury, cures only the chancre and the 
lues venerea, and the gonorrhoea is not the least affected by it; and 
what is still more remarkable is, that the two which it cures are in 
no respect similar, while the gonorrhoea, which it does not cure, is 
similar in some respects to the chancre, which it does cure. 

It may be remarked, in general, that there is not only a difference 
in the form of the disease, but also in the modes of cure, and in the 
times necessary for the cure of the different forms of the disease, even 
when the same medicines cure. The gonorrhoea, in its cure, is the 
most uncertain of the three, the chancre next, and the lues venerea 
the most certain, although cured by the same medicine which cures 
the chancre. 

A gonorrhoea in some cases shall be cured in six days, and in 
others require as many months; which, with regard to time, is about 
the proportion of thirty to one. A chancre may be sometimes cured 
in two weeks, and often requires as many months; which is in the 
proportion of four to one. The lues venerea in general may be cured 
in one or two months; which is only two to one. This calculation 
shows the regularity and irregularity, as to time, in the cure of each 
form of the disease. 

I have formerly observed, fhat indispositions of the body often 
affect this disease very considerably, more especially the gonorrhoea 
and the chancre. 

When an increase of symptoms takes place in a gonorrhoea, from 
an indisposition of body, nothing should be done for the gonorrhoea, 
the indisposition of body being only to be attended to; because we have 
no specific for the gonorrhoea, and in time it cures itself. But this 
practice is perhaps not to be followed in a chancre, or lues venerea. 
It may be necessary in those to continue the mercury, although per- 
haps more gently; for the mercury is a specific that cannot be dis- 
pensed with, because neither the chancre nor lues venerea are cured 
by themselves, but always increase. 

This form of the venereal disease I have divided into two stages. 
When in the parts most susceptible of the disease, which I have call- 
ed the first order of parts, and which appear to be the su- 
perficies only, the lues venerea is perhaps subject to less variety than 
either the gonorrhoea or chancre, and its mode of cure is of course 
more uniform, although the disease be less easily ascertained, at least 
for some time. In the second order of parts the lues venerea be- 
comes more complicated, and its cure still less to be depended upon. 
The cure of this form is much more difficultly ascertained than 
either of the two former, they being always local, and their effects 
visible, become more the objects of our senses, so that we are sel- 



CHAP. HI. OF THE LUES VENEREA. 309 

dom or ever deceived in the cure, although at the same lime the 
cure is often more tedious and difficult; for, whenever the symptoms 
of the gonorrhoea or chancre have entirely disappeared, in general 
the patient may look upon himself as cured of them; but this is not 
the case in the lues venerea. 

A lues venerea is the effects of the poison having circulated in the 
blood till it has irritated parts so as to give them a venereal disposi- 
tion, which parts sooner or later assume the venereal action, accord- 
ing to the order of their susceptibility. 

When the venereal matter is circulating, I have supposed that cer- 
tain parts are irritated by it, and that a vast number of other parts 
escape, as is evidently the case with the chancre; for in the case of 
a chancre the whole glans, prepuce, and skin of the penis, have had 
the matter applied to them, yet only one or more parts are contami- 
nated or irritated by it, all the others escaping; and we often see in 
the lues venerea, that when the parts contaminated assume the ac- 
tion, it is confined to them without affecting other parts, although the 
disease be allowed to go on for a considerable time without any at- 
tempt to a cure; and also, if these parts are imperfectly cured, the 
disease only returns in them; therefore these effects, although arising 
from the constitution, are in themselves entirely local, similar to the 
gonorrhoea and chancre, and like them may be cured locally; and 
the person may still continue to have the lues venerea, although not 
in these, yet in other parts, because there may be many other parts 
in the same body that are under the venereal disposition, although 
they may not yet have assumed the venereal action. To cure the 
local and visible effects of the disease, we must attack it through 
that medium by which it was communicated, that is, the blood, with- 
out however considering the blood itself as diseased, or containing 
the poison, but as the vehicle of our medicine, which will be car- 
ried by it to every part of the body where the poison was carried, 
and in its course it will act upon the diseased solids. This practice 
must be continued some time after all symptoms have disappeared; 
for the venereal action may to appearance be stopped, and symptoms 
disappear, and yet all return again, the venereal action not being 
completely destroyed. If the medicine were also a cure for the dis- 
position in the parts second in order, and could prevent their coming 
into action, it would be necessary to continue it somewhat longer on 
their account; but this is not the case, for the visible effects, symp- 
toms, or appearances, in the first order of parts, give way to the 
treatment, while the parts that have only acquired the disposition, 
and are still inactive, afterwards assume the action and continue the 
disease. This deceives the surgeon, and leaves the ground-work for 
a second set of local effects in the parts second in order; but I have 
asserted, that what will cure an action will not cure a disposition; if 
so, we should push our medicine no further than the cure of the vi- 



310 OF THE LUES VENEREA. CHAP. III. 

siblc effects of the poison, and allow whatever parts may be contami- 
nated to come into action afterwards. 

The parts that first assume the venereal action are the easiest of 
cure; and I have suspected that those effects of the disease, being 
external, were in some degree assisted in their cure by the local ac- 
tion of the medicine, which evidently passes off through those parts. 

When the disease has attacked the parts second in order of sus- 
ceptibility, it generally happens that they are more difficult of cure 
than the former; therefore, when they are affected at the same time 
with the former, and are cured, we may be sure that the first will 
be also cured. From hence, as it would appear, that the parts most 
susceptible of the disease are also easiest of cure, it follows that the 
parts least susceptible of the disease are also most difficult of cure; 
and I believe that this is seldom or never reversed, therefore those 
second in order of susceptibility have this advantage, that we have 
the local complaints for our guide to judge of the whole; and in such 
we have only to continue the treatment till they all vanish, being 
certain that the cure of the first, if there are any, will be involved 
in those of the second. 

As the second are attended with more tumefaction or swelling than 
the first, it becomes a question, whether the mercurial course should 
be continued till the whole has subsided. But I believe it is not ne- 
cessary to continue the method of cure till the whole tumefaction 
disappears; for as those local complaints cannot contaminate the 
constitution by re-absorption, and as the venereal disposition and ac- 
tion from the constitution can be cured while the local effects still 
remain, even where the tumefaction, forming nodes on the bones, 
fasciae, &c. is carried the length of suppuration, there can be no 
occasion for continuing the course longer than the destruction of the 
venereal action. But this effect of our medicine is not easily known, 
therefore it will be necessary to pursue the method of cure till the 
appearances become stationary, and probably a little longer, to de- 
stroy the whole action of the disease. From these circumstances, 
it would appear, that the venereal irritation, when in this stage of the 
disease, is easier of cure than the effects of that irritation, such as 
the tumefaction. 



This chapter cannot be well understood, unless the reader is pre- 
viously well acquainted with the doctrine of the disease. This in- 
troductory part, like too many others, is somewhat confused, and in 
the first paragraph there is a kind of attempt at paradox which is 
neither necessary, nor in my little opinion perfectly founded. That 
the three forms of the disease, as stated, exist, is to me unquestion- 
able; but I have endeavoured to show that all three are cured bv si- 
milar means, though in different degrees. The respective irregula- 



THAP. III. OF THE LUES VENEREA. 311 

1'ilies in the period of cure are easily accounted for. As we can 
only ascertain that the gonorrhea is cured by the cessation of the dis- 
charge, we cannot wonder at the uncertainty of that period, when 
we consider the variety of its causes, and that a discharge may con- 
tinue after the virulent properties of the venereal gonorrhoea have 
ceased. The period of curing a chancre is rendered more uncertain 
than it would be, because our patient is rarely confined by the dis- 
ease, and even if never interrupted in the use of the remedy, it is 
impossible to say, what circumstances he may be exposed to which 
may accelerate or retard the mercurial irritation. If in the bones 
or their appendages, the disease is usually serious enough to require 
the patient's confinement. There seems a contradiction between the 
middle and close of the long paragraph. It is first said, that the 
means of cure " should be continued some time after all the symp- 
toms have disappeared;" and, at the close, that " we should push 
our medicine no further than the cure of the visible effects of the 
poison." It must be admitted, that in a work of such importance, 
even this seeming contradiction is hardly allowable, though it is easily 
explained by a proper attention to the context, and to the doctrine of 
the laws of the disease. In the first of the sentences, we may ob- 
serve, that the author confines himself to the " venereal action" 
which, he says, " may to appearance be stopped and symptoms dis- 
appear, and yet all return again, the venereal action not being com- 
pletely destroyed." That is, though the symptoms may disappear, 
yet we cannot assert that the action is altogether superseded. But 
this is confined to the order of parts in which the symptoms have 
appeared, or the action commenced. We are not to continue the re- 
medy with any expectation of preventing the occurrence of the dis- 
ease in parts in which it has not hitherto shewn itself, for in these 
the disposition only exists, the action of the disease not having taken 
place; and " I have asserted," says he, " that what will cure an 
action will not cure a disposition." In fewer words, if lues vene- 
rea has appeared in the soft parts only, by continuing the mercury a 
short time after you have cured it in those soft parts, you may be sure 
that the disease will not re-appear in them; but it will be in vain to 
continue the remedy with any view of preventing the disease from 
appearing in the bones. If they have not been contaminated, they 
will not show the disease; if they are, the disposition is formed, 
which cannot be cured. We must wait till the action commences, 
which may be cured. 



312 OF THE LUES VENEREA. CHAP. Ilf. 

SECTION I. 

Of the Use of Mercury in the Cure of the Lues Venerea. 

Mercury, in the lues venerea, as in the chancre, is the great spe- 
cific, and hardly any thing else is to be depended upon. It is neces- 
sary that we should always consider well the effects of this medicine, 
both on the constitution at large, and the disease for which it is 
given. The effects of mercury on a constitution will always be as 
the quantity of mercury in that constitution; and when the same 
quantity affects one constitution more than another, it is in the pro- 
portion of the irritability of that constitution to the powers of mer- 
cury, entirely independent of any particular preparation, or any par- 
ticular mode of giving it. 

With regard to the preparations of the medicine, and the modes 
of applying it, we are to consider two things: first, the preparation 
and mode that is attended with the least trouble or inconvenience to 
the patient; and, second, the preparation and mode of administering 
it that most readily conveys the necessary quantity into the consti- 
tution. 

Nothing can show more the ungrateful and unsettled mind of man, 
than his treatment of this medicine. If there is such a thing as a 
specific, mercury is one for the venereal disease in two of its forms; 
yet mankind are in pursuit of other specifics for the disease, as. if 
specifics were more common than diseases; while, at the same time, 
they are too often contented with the common mode of treating many 
other diseases for which they have no specific; and these prejudices 
are supported by the public, who have in their minds a dread of this 
medicine, arising from the want of knowledge of our predecessors in 
administering it; and many of the present age, who are equally ig- 
norant, take advantage of this weakness. 

Mercury in the constitution acts an all parts of the machine, cures 
those which are diseased, affecting but little those that are sound. 
Mercury is carried into the constitution in the same way as other 
substances, either externally by the skin, or internally by the mouth: 
it cannot, however, in all cases, be taken into the constitution in 
both ways; for sometimes it happens that the absorbents on the skin 
will not readily receive it, at least no effect will be produced, either 
on the disease or constitution, from such application; when this is 
the case it is to be considered as a misfortune, for then it must be 
given internally by the mouth, although possibly this mode may be 
very improper in other respects, and often inconvenient. On the 
other hand, it sometimes happens that the internal absorbents will 
not take up this medicine, or at least no effect is produced either 
ivpon the disease or constitution; in such cases it is right to try all the 



SECT. I. OF THE LUES VENEREA. 318 

different preparations of the medicine; for it will sometimes happen 
that one preparation will succeed when another will not. I have 
never seen a case where neither external nor internal applications of 
mercury were not absorbed; such a case must be miserable indeed. 

I may just observe here, that many surfaces appear to absorb this 
medicine belter than others; and most probably all internal surfaces 
and sores are of this kind; for when we find that thirty grains of ca- 
lomel rubbed in on the skin has no more effect than three or four 
taken by the mouth, it becomes a kind of proof that the bowels ab- 
sorb it best; also, when dressing a small sore with red precipitate 
produces a salivation, it shows that sores are good absorbing surfaces, 
especially too when we know that the lues venerea generally arises 
from a chancre. 

A patient with a stump which produced too much granulations, 
was dressed with ointment containing a large proportion of red pre-- 
cipitate; the sore was about the size of a crown piece. It very 
nearly brought on a salivation, and the patient was obliged to leave 
it off. 

A mulatto woman had upon her leg a very bad ulcer, which was 
about the breadth of two palms; it was dressed with red precipitate 
mixed with common ointment, which soon threw her into a violent 
salivation. 

A lady, in the month of December, 1782, was burnt over the 
whole breast, neck, and shoulders, as also between her shoulders, on 
which part deep sloughs were formed. The sores at first healed 
nearly up, and tolerably well for burns; but they broke out anew, 
and then became more obstinate. Seven months after the accident 
she came to London, with very large sores extending across the 
breast, and upon each side to the shoulders; they were extremely 
tender and painful. They continued to heal for some time after she 
came to London; but she became ill, having been affected with ex- 
treme irritability, loss of appetite, sickness, and throwing up of her 
food and medicines. At this time the sores again began to spread, 
and became very large. After having been two months in town with 
little advantage, I tried warmer dressings, as basilicon, to some parts, 
to see if any advantage would arise from such treatment, and it was 
found that these parts healed rather faster than the others; but the 
soreness was so great, even from the mildest dressings, that they 
could only be used in part. I next tried red precipitate mixed with 
the ointment; and, that it might increase the pain as little as possi- 
ble I ordered only ten grains to two ounces of the ointment. This 
appeared to agree better with the sores than the ointment alone; and 
we were happy in having found a dressing which both hastened on 
the cure, and was easier than the former. But about the fourth or 
fifth dressing from beginning the use of the precipitate she began to 
co nplain of her gums; the next day began to spit, and by the seventh 
or eighth dav the mouth was so sore, and the spitting so consider- 

° Rl' 



314 OF THE LUES VENEREA. CHAP. III. 

able, that, upon considering the case, we began to suspect that it 
might proceed from the red precipitate in the dressing. The gums, 
inside of the cheeks, and the breath, were truly mercurial. We im- 
mediately left off this dressing, except to a small corner, and had re- 
course to the former dressings. In a few days the effects of the mer- 
cury abated, and the sores looked more healthy than ever, and we 
again began to dress part of the sores with the ointment containing 
precipitate, which still agreed with them. When the mouth first 
became affected, she had not used much above one half of the oint- 
ment; and by the time we had discovered the cause, about three- 
fourths of it had been expended in dressings, so that there was not 
quite ten grains of precipitate applied; and although this took up 
seven or eight days, and the ointment must have been soon removed 
from the sore by the discharge, yet a considerable spitting was pro- 
' duced, which lasted above a month. It is hardly to be conceived that 
above a grain or two could really be taken into the constitution; for, 
when we consider the particles of precipitate were covered with oint^ 
ment, and a vast discharge of matter, so as soon to remove this small 
quantity from the sore, we can hardly admit the possibility of more 
being absorbed; and if this idea of the quantity taken in is jus;, to 
what must we attribute the great susceptibility to the effects of the 
medicine? Was it the irritable state of the patient at the time? For 
the state of the constitution appeared to me to be that in which the 
locked jaw often takes place; and I often had this disease in my 
mind. The patient afterwards got well by the use of an ointment in 
which pitch was an ingredient. All this tends to show that sores 
and internal surfaces absorb better than the skin. 

Besides the practicability of getting the medicine into the consti- 
tution in either way, it is proper to consider the easiest for the pa- 
tient, each mode having its convenience and inconvenience, which 
arises from the nature of the constitution of the parts to which it is 
applied, or from certain situations of life of the patient at the time 
It is therefore proper to give it in that way which suits these circum- 
stances best. 

To explain this further, we find that in many patients the bowels 
can hardly bear mercury at all, therefore it is to be given in the 
mildest form possible; also joined with such other medicines as will 
lessen or correct its violent local effects, although not its specific ones 
on the constitution at large. 

When it can be thrown into the constitution with propriety by the 
external method, it is preferable to the internal, because the skin is 
not nearly so essential to life as the stomach, and therefore is capa- 
ble of itself of bearing much more than the stomach; it also affects 
the constitution much less; many courses of mercury, which are ab- 
solutely necessary, would kill the patient if taken by the stomach 
proving hurtful both to the stomach and intestines, even when liven 
m any form, and joined with the greatest correctors: on the other 



SECT. 1. OP THE LUES VENEREA. 315 

hand, the way of life will often not allow it to be applied externally. 
It is not every one that can find convenience to rub in mercury, 
therefore they must take it by the mouth, if possible. To obviate the 
inconvenience often arising from the visible effects of mercury, many 
preparations have been invented; but any preparation of mercury 
producing an effect different from the simple effects of mercury in 
that constitution, such as sweating, or an increased discharge of urine, 
must be supposed either not to act as mercury, or the substance with 
Which it is compounded produces this effect; but if its peculiar ef- 
fects are less than usual, I should very much suspect that the mer- 
cury is acting in part as a compound, and not entirely as mercury- 
Mercury, like many other medicines, has two effects, one upon the 
constitution and particular parts, which is according to its mode of 
irritation, independent of any disease whatever. The other is its 
specific effects upon a diseased action of the whole body, or of parts, 
whatever the disease be, and which effects are only known by the 
disease gradually disappearing. The first becomes an object of con- 
sideration for the surgeon, as it is in some measure by them he is to 
be guided in giving this medicine so as to have its specific effects suf- 
ficient for the cure of the disease. 

Whatever injury mercury may do to the constitution, it is by its 
visible effects, and thence the pretended art in avoiding those visible 
effects has been too much the cause of great imposition. The part 
upon which its effects are most likely to fall is, the part that is in 
most cases attempted to be avoided, or guarded against, and that is 
the mouth. I believe that we are not possessed of any means of 
either driving the mercury to the mouth, or of preventing it from at- 
tacking that part. Cold and warmth are the two great agents men- 
tioned by authors; we find them recommending the avoiding of cold., 
for fear the mercury should fly to the mouth, as if warmth was a 
prevention; while others, and even the same authors, when talking 
of bringing the mercury to the mouth, recommend warmth, as if cold 
were a preventive. This being the case, we may reasonably sup- 
pose that neither the one nor the other have any material effect. 

In giving mercury in the venereal disease, the first attention should 
be to the quantity, and its visible effects in a given time; which, when 
brought to a proper pitch, are only to be kept up, and the decline of 
the disease to be watched; for by this we judge of the invisible or 
specific effects of the medicine, which will often inform us that some 
variation in the quantity may be necessary. 

The visible effects of mercury are of two kinds, the one on the con- 
stitution, the other on some parts capable of secretion. In the first, 
it appears to produce universal irritability, making it mote suscepti- 
ble of all impressions; it quickens the pulse, also increases its hard- 
ness, producing a kind of temporary fever; but in many constitutions 
it exceeds this, acting as it were as a poison. In some it produces a 
kind of hectic fever, that is, a small quick pulse, loss of appetite, 



316 OF THE LUES VENEREA. CHAP. Ill- 

restlessness, want of sleep, and a sallow complexion, with a number 
of consequent symptoms; but by the patient being a little accustomed 
to the use of it, these constitutional effects commonly become less, 
of which the following cases are strong instances. 

A gentleman rubbed in mercurial ointment for the reduction of 
two buboes. He had only rubbed in a few times when it affected 
his constitution so much that it was necessary to leave it off. He 
was seized with feverish complaints of the hectic kind, a small quick 
pulse, debility, loss of appetite, no sleep, and night sweats. He 
took the bark, with James's powder, and asses' milk, and got gradu- 
ally rid of these complaints. As the buboes were advancing, it was 
necessary to have recourse to mercury again ; and I told him that now 
it would not produce the same effects so quickly, nor so violently as 
before. He rubbed in a considerable quantity without his constitu- 
tion or mouth being affected; but the buboes suppurating, I ordered it 
to be left off a second time; and when they were opened he had re- 
course to the ointment again for the third time, and without produc- 
ing any disagreeable effects. The buboes put on a healing dispo- 
sition for a while, and then became stationary, showing that a new 
disposition was forming. He was directed to leave off the ointment 
and to bathe in the sea, which he did, and the buboes began to heal. 
In about three weeks, however, it was thought necessary to use more 
friction, and when he began, which was the fourth time, it had al- 
most an immediate and violent effect upon his mouth; he left off again 
till his mouth became a little better, and then returned to the mercu- 
ry a fifth time, and was able to go on with it. 

A stout healthy man used mercurial friction for a bubo till it af- 
fected his mouth; it further brought on very disagreeable constitu- 
tional complaints, such as loss of appetite, watchfulness, sallow com- 
plexion, lassitude from the least exercise, and swelled legs; and al- 
though various means were used to reconcile the constitution to it, 
yet it continued to act as a poison. 

Mercury often produces pains like those of the rheumatism, and 
also nodes which are of a scrofulous nature, from thence it has 
been accused of affecting the bones, " lurking in them," as authors 
have expressed it. 

It may be supposed to be unnecessary to mention, in the present 
state of our knowledge, that it never gets into the bones in the form 
of a metal, although this has been asserted by men of eminence and 
authority in the profession; and even the dissections of dead bodies 
have been brought in proof of it; but my experience in anatomy has 
convinced me that such appearances never occur. Those authors 
have been quoted by others; imaginary cases of disease have been 
increased; the credulous and ignorant' practitioner misled, and pa- 
tients rendered miserable. 



SECT. H. OF THE LUES VENEREA. 817 

SECTION II. 

Oftlie Quantity of Mercury necessary to be given. 

The quantity of mercury to be thrown into the constitution for 
the cure of any venereal complaint must be proportional to the vio- 
lence of the disease. Two circumstances are, however, to be strictly 
attended to in the administration of this medicine; which are, the 
time in which any given quantity is to be thrown in, and the effects 
it has on some parts of the body, as the salivary glands, skin, or in- 
testines. These two circumstances, taken together, are to guide us 
in the cure of the disease; for mercury may be thrown into the same 
constitution in very different quantities so as to produce the same 
ultimate effect; but the two very different quantities must be 
also in different times; for instance, one ounce of mercurial oint- 
ment, used in two days, will have more effect upon the consti- 
tution than two ounces used in ten; and to produce the same ef- 
fect in the ten days, it may perhaps be necessary to use three ounces 
or more. 

The effects, on the constitution, of one ounce, used in two days, 
are considerable, and also its effects upon the diseased parts; 
therefore a much less quantity in such a way will have greater ef- 
fects; but if these effects are principally local, that is, upon the 
glands of the mouth, the constitution at large not being equally 
stimulated, the effect upon the diseased parts must also be less, 
which is to be determined by the local disease not giving way in 
proportion to the effects of the mercury on some particular part. 

If it is given in very small quantities, and increased gradually, so 
as to steal insensibly on the constitution, its visible effects are less, 
and it is hardly conceivable how much may at last be thrown in, 
without having any visible effect at all.* 

These circumstances being known, it makes mercury a much 
more efficacious, manageable, and safe medicine, than formerly it 
was thought to be; but unluckily its visible effects upon some par- 
ticular parts, such as the mouth and the intestines, are some- 
times much more violent than its general effect upon the consti- 
tution at large; therefore a certain degree of caution is necessary, not 



• To tnve an idea of this, ten grains of the ointment used every day, dar 
iiur ten days, affected a gentleman's month. The ointment was of equal 
Darts of mercurv and hogs'-lard. But, by means of omittmg the ointment 
occasionally, and' returning to the use of it, he at last rubbed in eighty grain- 
every night for a month, without having his mouth, or any of the secretins, 
visibly affected. 



318 OV THE LUES VENEREA. CIIAF. HI- 

to stimulate these parts too quickly, as that will prevent the necessary 
quantity being given. 

The constitution, or parts, are more susceptible of mercury at first 
than afterwards; if the mouth is made sore, and allowed to recover, 
a much greater quantity may be thrown in a second time, before t.ic 
same soreness is produced; and indeed I have seen cases where it could 
not be reproduced by as much mercury as possibly could be thrown in. 
Upon a renewal of the course of mercury, therefore, the same pre- 
cautions are not necessary as at first. We are, however, every now 
and then deceived by this medicine, it being hardly possible to pro- 
duce visible effects at one time; and afterwards the mouth and in- 
testines shall all at once be affected. 

Mercury, when it falls on the mouth, produces in many constitu- 
tions violent inflammation, which sometimes terminates in mortifica- 
tion. The constitutions in which this happens, f suspect, are of the 
erysipelatous kind, or what are called the putrid; therefore in such 
greater caution is necessary. Mercury, in general, that is, where it 
only produces its common effects, seldom or never does any injury to 
the constitution. It should seem only to act for the time, and to leave 
the constitution in a healthy state. But this is not always the case, 
for probably mercury can be made to affect every constitution very 
materially, being capable of producing local diseases, as has been 
mentioned; and also capable of retarding the cure of chancres, 
buboes, and certain effects of the lues venerea, after the poison 
has been destroyed. 



SECTION III. 

Of the sensible Effects of Mercury upon Paris. 

The sensible effects of mercury are generally an increase of some 
of the secretions, a swelling in the salivary glands, and increase of 
saliva; an increase of the secretion of the* bowels, which produces 
purging, and an increase of the secretion of the skin, producing 
sweat, also often an increase of the secretion of urine. Sometimes 
one of these secretions only is affected, sometimes more, and some- 
times all of them together. But the effects upon the mouth are the 
most frequent. 

Mercury often produces headachs, and also costiveness, when 
its action on other parts becomes sensible, especiallv upon the glands 
of the mouth. 

When the mercury falls upon the mouth, it does not affect all parts 



SECT. III. OF THE LUES VENEREA. 319 

of it equally, sometimes attacking the gums, at other times the cheeks, 
which hecome thickened, and ulcerate, while the gums are not in the 
least affected, as appears by the patient being capable of biting any 
thing hard. 

Mercury, when it falls upon the mouth, and parts belonging to 
the mouth, not only increases the discharge of those parts, but it 
brings on great tumefaction, which is not of the true inflammatory 
kind, where coagulable lymph is thrown out, but rather resembling 
erysipelatous tumefaction. The tongue, cheeks, and gums swell, 
and the teeth become loose; all which effects are in proportion to 
the quantity of mercury given, and susceptibility of the parts for 
such irritation. It produces great weakness in the parts, in 
which ulceration easily takes place, especially if they are in the 
least irritated, which is often done by the teeth, and even mor- 
tification sometimes ensues. How far it produces similar effects 
when it falls on other parts, I do not know. The saliva, in such 
cases, is generally ropy, as if principally from the glands affected. 
The breath acquires a particular smell. 

As mercury generally produces evacuations, it was naturally im- 
agined that it was by this means that it effected a cure of the vene- 
real disease; but experience has taught us, that, in curing the vene- 
real disease by this medicine, evacuations of any kind, produced by 
it, are not at all necessary; and this might have been supposed, as 
similar evacuations, produced by other medicines, are of no service; 
therefore it was reasonable to imagine that these evacuations, when 
produced by mercury, were also of no service; except we could sup- 
pose that the evacuation, produced by the mercury, was not the 
same with that produced by other medicines, but that it was a spe- 
cific evacuation; that is to say, a discharge earning off the venereal 
poison by its union with the mercury; and therefore the faster the 
mercury went off, the sooner would the poison be carried out of the 
constitution. But this is not found to be the case in practice; on 
the contrary, evacuations produced by the medicine retard the 
cure, especially if the secretory organs are too susceptible of this 
' stimulus; for then the quantity which is necessary, or sufficient 
for the cure of the disease, cannot be taken in, the effects of 
the medicine upon particular parts being greater than the patient 
can bear; and the quantity of mercury to be thrown into the con- 
stitution must be limited and regulated according to the quantity 
of evacuation, and not according to the extent of the disease. 
On the other hand, if it is given with care, so as to avoid violent 
evacuation, any quantity may be thrown in sufficient for the cure of 
the disease. 

Certain evacuations may be supposed to be a mark ot the con- 
stitutional effects of mercury; but they are not to be entirely depend- 
ed upon the secretions being only a proof of the susceptibility oi 
some parts to such a stimulus; however, it is probable, that in general 



320 OF THE LUES VENEREA, CHAP. HI- 

they are a good gauge of its constitutional effects. Some have gone 
so far as to suppose that quantity of mercury alone, without any sen- 
sible effects, is sufficient for the cure of the disease; and this is in 
some degree the case, but not completely so, for we have no good 
proof of its affecting the constitution but by its producing an increase 
of some of the secretions. 



SECTION IV. 

Of the Action of Mercury. 

Mercury can have but two modes of action, one on the poiscfe, 
the other on the constitution; we can hardly suppose it to act both 
ways. If mercury acted upon the poison only, it might be supposed 
to be in two ways, either by destroying its qualities by decomposing it, 
or by attracting it and carrying it out of the constitution. If the first 
were the action of mercury, then we might reasonably suppose 
that quantity alone would be the thing to be depended upon; if 
the second, that the quantity of evacuation would be the principal 
circumstance. 

But if it act upon the principle of destroying the diseased actioH 
of the living parts, counteracting the venereal irritation by produc- 
ing another of a different kind, then neither quantity alone, nor 
evacuation, will avail much; but it will be quantity joined with sen- 
sible effects that will produce the quickest cure, which from expe- 
rience we find to be the case. But although the effects that mer- 
cury has upon the venereal disease are in some degree in proportion 
to its local effects on some of the glands, or particular part of the 
body, as the mouth, skin, kidneys, and intestines, yet it is not exactly 
in this proportion, as has been mentioned. When mercury disa- 
grees, as it were, constitutionally, producing great irritability and 
hectic symptoms, this action, or irritation, is not a counter-irritation 
to the venereal disease, but is a constitutional irritation, having no 
effect on the disease, which continues to increase. Mercury, losing 
its effects upon the disease by use, gives a proof that it neither acts 
chymically, nor by carrying off the poison by evacuation, but by its 
stimulating power. 

The effects will always be in proportion to the quantity in a given 
time, joined with the susceptibility of the constitution to the mercu- 
rial irritation. These circumstances require the minutest attention; 
and in order to procure its greatest action with safety, and to procure 
this in the most effectual way, it must be given till it produces local 
effects somewhere, but not too quickly, that we may be able to throw 



SECT. IV. OF THE LUES VENEREA. 321 

i n a proper quantity; for local effects produced too quickly prevent the 
sufficient quan'.i.y being thrown in for counteracting the venereal ir- 
ritation at large. I have seen cases where the mercury very readily 
acted locally, and yet the constitution was hardly affected by it, for 
the disease did not give way. 

A gentleman had a chancre, which he destroyed with caustic, and 
dressed the sore with mercurial ointment. He had also a slight un- 
easiness in one of his groins, which went no further, but which show- 
ed an absorption of the poison. The chancre soon healed, and he 
rubbed in about two ounces of mercurial ointment. He began this 
course with small quantities, that is, a scruple at each rubbing, and 
increased it; however it soon affected his mouth, and he spit for about 
a month. Two months after he had a venereal ulcer in one of his 
tonsils. Here was a considerable sensible effect from a small quan- 
tity of mercury, which proved ineffectual, because its specific effects, 
.^as I apprehend, were not in proportion to its sensible effects; the sa- 
livary glands being too susceptible of the mercurial irritation. 

On the other hand, I have seen cases, where quantity did not an- 
swer till it was given so quickly as to affeci the constitution in such 
a manner as to produce local irritation, and consequently sensible 
evacuations, which is a proof that the local effects are often the sign 
of its specific effects on the constitution at large, and shows that the 
susceptibility of the diseased parts, to be affected by the medicine, is 
in proportion to the effects of it upon the mouth. Its effects are not 
to be imputed to evacuation, but to its irritation, therefore mercury 
should be given, if possible, so as to produce sensible effects upon 
some parts of the body, and in the largest quantity of mercury that 
can be given to produce these effects within certain bounds; and that 
these sensible effects should be the means of determining how far the 
medicine may be pushed, in order to have its best effects upon the 
disease without endangering the constitution. The practice here 
must vary according to "circumstances; and if the disease is in a vio- 
lent degree, less regard must be had to the constitution, and the mer- 
cury is to be thrown in in large quantities; but if the disease be mild, 
it is not necessary to go beyond that rule, although it is better to keep 
ap to it on purpose to cure the disease the sooner. 

If the disease is in the first order of parts, a less quantity of mer- 
curv is necessary than if it were in the second order of parts, and had 
been of long standing, with its first appearances only cured, and the 
venereal disposition still remaining in the secondary parts. To cure 
the disease, whether in the form of chancre, bubo, or lues venerea, 
probably the same quantity of mercury is necessary; for one sore re- 
quires as much mercury as fifty sores in the same person, and a small 
sore as much as a large one; the only difference, if there is any, must 
depend upon the nature of the parts affected, whether naturally active 
or indolent. If there be any material difference between the recent 
and constitutional, which, I apprehend, there is, it may make h djf- 



322 OF the lues venerea. chap, in- 

ference in the quantity. I do eonceive that the recent are upon the 
whole more difficult to cure; at least they commonly require longer 
time, although not always. 

Having thus far premised these general rules and observations, I 
shall now give the different methods of administering mercury. 



We have so much anticipated this part of the work, that we shall 
have few remarks to make, and those few will be principally to show 
that a mind capacious enough to confine to certain laws those actions 
in which our complicated machine deviates from, and returns again 
to its ordinary course, should still feel so conscious of the possibility 
of error as to wish as far as possible to reconcile his discoveries with 
established practices. The whole doctrine of cure is reducible to a 
simple law, which daily experience confirms, viz. that the constitu- 
tion has no power to alter the action excited by the venereal disease; 
yet as the disease only exists in the action excited by it, and as two 
actions cannot be carried on at the same time in the same parts, or in 
the same constitution, so i'»a greater action is excited than the venereal 
action, the latter must be superseded. But to secure this we should 
not only excite a considerable action, but one which will occupy 
every part in which the venereal action formerly existed. We must 
also be certain that this new action being disease, may be such as 
will gradually cease when the means by which it was excited are no 
longer applied. 

Under these circumstances, what are the fair, not to say the ne- 
cessary inferences? — That you must excite the mercurial* action as 
quickly as you can, keeping it up a longer or shorter time, in propor- 
tion as the venereal action, by having continued a longer or shorter 
time, may have extended its 'local influence further, and have ha- 
bituated the constitution to such an action. The quantity of mer- 
cury required for this must depend on the constitution, concerning 
which we must gain all the information we can, and also watch the 
condition of it as long as we find it necessary to continue the reme- 
dy. Provided the constitution is so affected by the mercurial action 
as to supersede the venereal action, the quantity of mercury used can 
be of no consequence. The illustration given by Mr. Hunter 
[p. 320] that the mercurial irritation is not to be induced too quick- 
ly, that we maybe able to throw in a proper quantity, is evidently a 
concession to the prejudices entertained before he had taught us to 
think justly on the subject. The patient was cured of the chancre 
which never returned. The throat must have been contaminated' 
whilst the chancre existed, for after that was healed, there was no 
source of contamination. The disposition being thus formed, the ac- 
tion commenced about the usual period after the mercurial irritation 
ceased; in other words, no mercury being used to hinder it, whilst 
the chancre existed, a disposition was formed, and the subsequent use 



SECT. V. OP THE LUES VENEREA. 323 

of mercury could not cure that disposition. The case, as related, 
forms a just illustration of the doctrine; but the inference is either 
contradictory to the doctrine, or absolutely unintelligible. The se- 
cond paragraph of the following section 'shows that the effect pro- 
duced by mercury is all that the author seemed to think of import- 
ance. All the other observations on mercury are such as we might 
expect from so accurate an observer. 



SECTION V. 

Of the different Methods of giving Mercury externally — internally. 

Previously to the giving of mercury, it is very proper to under- 
stand, as much as possible, the constitution of the patient with regard 
to this medicine, which can only be known in those who have already 
gone through a mercurial course; but as many of our patients are 
obliged to undergo this treatment more than once, it becomes no vague 
inquiry; for as there arc many who can bear this medicine much bet- 
ter than others, it is very proper that this should be known, as it will 
be a direction for our present practice. I think that few constitutions 
alter in this disposition; although I knew one case which admitted 
of a considerable quantity atone time without being visibly affected; 
but about a twelvemonth after, the patient was affected with a very 
little. 

When mercury is given to cure the lues venerea, whatever length 
we mean to go in the sensible effects of it, we should get to that, 
length if possible, and we should keep up to it; for we shall find it 
diificult to bring its effects to that standard again, if we allow it to 
get below it. If the mercury should get beyond what we intended, 
we should be very much upon our guard in lowering it; and should 
probably begin to give it again before its effects are reduced to the in- 
tended standard: for the same quantity now will not operate so pow- 
erfully as before; insomuch that what at first produced greater effects 
than was intended, will not be sufficient afterwards. 

Mercury is best applied externally, in form of anointment. Unc- 
tuous substances keep it divided, attach it to surfaces, and do not dry; 
it mav also be supposed that they become a vehicle for the mercury, 
and carry it through the absorbents to the general circulation; for it is 
probable that oil is as easy of absorption as watery substances. 

If the symptoms are mild in the first order of parts, and the patient 
not accustomed to mercury, or it is known that he cannot bear the 
medicine in great quantity, and it is intended to conduct the cure by 
almost insensible means, it is proper to begin with small quantities. 



324 OF THE LUES VENEREA. CHAP. III. 

One scruple, or half a drachm, of an ointment made of equal parts of 
quicksilver and hog's-lard, rubbed in every night, for four or six nights, 
will be sufficient to begin with. If the mouth is not affected, the 
quantity may be gradually increased till two or three drachms are 
rubbed in at each time; but if the first quantity has affected the 
mouth, we may be almost certain that the glands of the mouth are 
very susceptible of the mercurial stimulus; therefore it will be pro- 
per to wait two or three days tili that effect begins to go off. 

When we begin the second time, the quantity may be gradually- 
increased, at least a scruple every time, till two drachms or more are 
rubbed in each night, which may be done without affecting the pa- 
tient very considerably a second time, as has been already ob- 
served. 

If all the symptoms gradually disappear, there is no more to be 
done but to continue this practice for a fortnight longer, by way of 
security. 

This method, steadily pursued, will cure most recent cases of lues 
venerea; but it is not sufficient if the disease has been merely kept 
under by slight courses of mercury: a. greater quantity becomes ne- 
cessary, from a kind of habit the constitution has acquired, by which 
it is rendered less susceptible of the mercurial stimulus. 

If the disease should return in the second order of parts, we may 
be certain the same quantity of mercury will not he sufficient to cure 
them, their action being slow under the venereal imitation, therefore 
requiring more than what had been first given. 

I may be allowed to remark, that, where the venereal svmptoms 
have been ulcers in the mouth or throat, I have suspected that the 
mercury being brought to the mouth, and the saliva being impreg- 
nated with it, and acting as a mercurial gargle, cured those parts lo- 
cally; and that the constitution has remained still tainted; the mer- 
curial action in it having been much inferior to what it was in the 
mouth. Perhaps something similar may take place in eruptions of 
the skin where the mercury passes off by sweat; for we know that 
sulphur will cure the itch by passing off in perspiration. If these 
are facts, then it may in some degree account for the local symptoms 
in the first order of parts being easier of cure than those in the se- 
cond. 

The manner of living under a mercurial course need not be al- 
tered from the common, because mercury has no action upon the dis- 
ease which is more favoured by one way of life than another. Let 
me ask any one what effect eating a hearty dinner, and drinking a 
bottle of wine, can have over the action of mercury upon a vene- 
real sore, either to make it affect any part sensibly, as falling upon 
the glands of the mouth, or prevent its effect upon the venereal irri- 
tation? In short, 1 do not see why mercury should not cure the ve- 
nereal disease under any mode whatever of regimen or diet. 

I own, however, that I can conceive cold affecting the operations 



SECT. V. OP THE LUES VENEREA. 



325 



of mercury upon the venereal disease; it is possible that cold may 
be favourable to the venereal irritation, and therefore contrary to 
that produced by mercury; and there is some show of reason for 
supposing this: for I have before asserted, that 'cold was an encou- 
rager of "the venereal irritation; and therefore keeping the patient 
warm may diminish the powers of the disease while under the 



cure. 



Mercury, given internally, is in many cases sufficient, although in 
general it 'is not so much to be depended on as the external applica- 
tion; therefore I would not recommend it, or give it in cases where 
the disease has not been sufficiently cured by former courses of mer- 
cury It is the most convenient way of giving this medicine; for 
many will swallow a pill who do not choose to rub the body with 
the ointment: indeed, there are many circumstances in lift which 
make this mode of introducing it into the constitution the most con- 
venient; but, on the other hand, there are many constitutions that 
cannot bear mercury given internally. When these two circumstances 
meet in the same patient, it is unfortunate. 

Mercury, taken internally, often produces very disagreeable effects 
upon the stomach and intestines, causing sickness in the one, and 
griping and purging in the other. 

If it be found necessary to give it internally, and it disagrees 
either with the stomach or intestines, or both, even in the most sim- 
ple preparation, its effects, whatever they arc, must be corrected or 
prevented, by joining with the mercury other medicines. If it affect 
the stomach only, the mercurv may be joined with small quantities 
of the essential oils, as the essential oil of cloves, or camomile flow- 
ers, which will in many cases take off that effect. If it disagree 
both with the stomach and bowels, which I believe arises either 
from the mercury meeting with an acid in the stomach, by which 
part of it is dissolved, forming a salt, or from being given in the form 
of a salt both of which will generallv purge, and become the cause 
of their own expulsion. There are two ways of obviating these ef- 
fects- the first is, by preventing the salt from forming; the second, 
by mitigating its effects on the intestines, if forming, by taking oft 
their irritability. To prevent the salt from forming, the best way is 
to join the mercury with alkaline substances, either salts, or earths; 
antl when given in a saline state, it may be joined with opium, or 
some of the essential oils. 

To prevent the formation of the salt, take of the preparations ot 
mercury such as mercurius calcinatus, mercurius fuscus, or calomel, 
forming them into pills, with the addition of a small quantity of soft 
soap or anv of the alkaline salts; the alkaline salt also prevents the 
pill from drying: or, instead of these, a calcareous earth may be 
Joined with the mercurv, such as chalk or crabs - * «n this 

nrinciple is the mercurius alkalizatus, which is crude mercurv, rub- 
bed down with crabs'-eves. But these substances add considerably 



326 OF THE LUES VENEREA. CHAP. III. 

to the bulk of the medicine, no less than twenty grains being neces- 
sary for a dose; which contain seven grains and a half of crude mer- 
cury. The mercurius calcinatus, rubbed with a small portion of 
opium, makes an efficacious pill, and in general agrees well both 
with the stomach and bowels. Opium has long been joined with 
mercury to cure the venereal disease. By some as much has been 
attributed to the opium as the mercury: however, opium should be 
given with care, for it is not every constitution with which it agrees, 
often producing irritability, in some lassitude and debility, in others 
spasms. 

If the mercury is not given in the above manner, but in the form 
of a salt, or the salts are allowed to form, then it should be joined 
with one third of opium, and a drop of the oil of cloves, or camo- 
mile, which will make it agree with the stomach, and prevent its 
purging; or, if it is found still to disagree both with the stomach and 
bowels, compound it still further, by joining with the mercury the 
alkaline salts, the opium, and some essential oil. 

A grain of mercurius calcinatus made into a pill, with the addi- 
tion of such medicines as the stomach or bowels may require, may 
be given every night for a week; and if in that time it has not af- 
fected the mouth, it may be repeated evening and morning; and af- 
ter the patient has been accustomed to the medicine, and it is found 
not to fall much upon the mouth, it may be increased to two grains 
in the evening, and one in the morning. 

The same directions hold equally good, either with the mercurius 
fuscus, or calomel; but it requires more of these last preparadons of 
mercury to have the same medicinal effect upon the diseas an of 
the before mentioned; perhaps the proportion of their sheets are 
about two or three to one. Why this should be the case is probably 
not easily accounted for, the quantity of mercury being very nearly 
the same in a given weight in both, for in eight grains of calomel 
there are seven grains of crude mercury. Three grains of these 
preparations appear only equal to one of the mercurius calcinatus. 
The crude mercury, given in the same quantities with either of the 
former, appears the least efficacious of all; for fifteen grains of crude 
mercury, rubbed down with any mucilage, seems only equal to one 
or two of the mercurius calcinatus. 

The corrosive sublimate, which is a salt capable of stimulating 
violently, is generally given in solution in common water, brandy, or 
some of the simple waters, and has been used with the appearance 
of considerable success. It would appear that it removes ulcers in 
the mouth, as soon, if not sooner, than any of the other preparations; 
but this, I suspect, arises from its application to these parts in its pass- 
age to the stomach, acting upon them locally as a gargle; however, 
from experience, it appears not to have sufficient powers over the ve- 
nereal irritation; in recent cases only removing the visible local ef- 
fects, without entirely destroying the venereal action; for many more 



SECT. V. OF THE LUES VENEREA. 327 

have been found to relapse, after having taken this preparation, than 
from many of the others; which is owing to its passing very readily 
off by the skin. Besides, it disagrees much more with the stomach 
and intestines than any of the other preparations. 

A grain of this medicine, dissolved in about an ounce of some 
fluid, is generally the dose, and increased according as it agrees 
with the bowels, and according to its effects upon the mouth, and 
disease. 

As corrosive sublimate contains an acid, and as you must be 
guided by the effects of the acid on the bowels, the quantity of mer- 
cury you can give in this form is necessarily smaller than in the other 
preparations. Ward's drop, containing less acid, can be given in 
larger quantity, and is more efficacious on that account. Perhaps 
any of these preparations, united with a scruple of gum guaiacum, 
may have more effect than when given alone; since guaiacum is 
found to have considerable effects on the venereal disease.* 

This practice, continued for two months, will in general cure a 
common lues venerea; but here it is not meant that any time should be 
specified. After all the symptoms of the disease have disappeared,, 
this course should be continued at least a fortnight longer; but if the 
symptoms disappear very suddenly, as they often do, perhaps within 
eight or ten days, probably from the medicine going off by those sur- 
faces where the disease appears, the medicine should be continued 
three weeks, or perhaps a month longer, and the dose increased. In 
such cases the visible local effects appear to be cured, while a vene- 
real disposition remains in the parts. 

Various are the preparations of mercury recommended for internal 
use, while practitioners have generally been satisfied with but one 
for external application. Every practitioner finds some one of the 
preparations answering better to appearance in some one case than 
another, which casts the balance in favour of that medicine in Ins 
mind; or others, finding the bad effects of a particular preparation at 
some one time, have generally condemned that preparation; not to 
mention that deceit is often practised in the cure of this disease. 
One would naturally suppose that the simplest preparation is the best,, 
that which is easiest dissolved in the animal juices, does least mis- 
chief to the stomach, or general health, and is least disturbed or hin- 
dered in its operations; for we can hardly suppose that any substance 
joined with mercury, which alters either its chymical or mechanical 
properties out of the body, can add to its power in the body, except 
a substance which had a similar power when acting alone. The pre- 
ference generally given to the ointment shows this; and if we could 
find a preparation still more simple than the ointment, that prepa- 
ration should be used in preference to the crude mercury. 

• See pages 231, 257. 



323 OF THE LUES VENEREA.. CHAP. I. 

SECTION VI. 

Of the Cure of the Disease in the second or third Stage. 

In the more advanced stages of the disease the mercurial course 
must be pushed further. The greatest medicine that the patient can 
bear at a time is to be thrown in, and continued with steadiness till 
there is reason to suppose the disease is destroyed. It will not be 
possible in such cases to prevent the mouth from being considerably 
affected, the quantity of mercury necessary to be used for the cure 
of these stages of the disease being such as will, in most cases, pro- 
duce that effect. 

Before the disease has advanced so far, the patient most probably 
has taken mercury, and it is proper to inquire how he has been af- 
fected by it, and what quantity of it he can bear, which will, in some 
degree, direct us in the quantity now to be begun with. If the pa- 
tient has not taken mercury for a considerable time, and is easily af- 
fected by it, which is the case that admits of the least quantity, it wilL 
be necessary to begin cautiously, regulating the quantity according 
to circumstances; but, if the person has taken mercury lately, al- 
though easily affected by it, more freedom may be used on returning 
to it, because it will have less power on his mouth, as also on the 
disease; again, if the person has been taking mercury very lately, 
and is with difficulty affected by it, which is the case that admits of 
the greatest quantity, then it may be administered freely so as to af- 
fect the constitution in the proper time. If the mercury is brought 
to the mouth in six or eight days, and a considerable soreness is pro- 
duced in twelve, it will, in general, be a good beginning. In such 
cases the constitution is, if possible, to be surprised by the medicine, 
so as to produce its greatest effects; but with such caution as to be 
able to keep up these effects by quantity. 

Mercurial friction will answer better than mercury given internal- 
ly; for in this way, we are surer of throwing in a larger quantity in 
a given time, than could be taken internally without hurling the 'sto- 
mach. 

The quantity of mercury applied in this way should be under cer- 
tain circumstances, in an inverse proportion to the surface on which 
it is applied, and the surface should be completely covered with the 
ointment; for half an ounce of mercurial ointment, rubbed in upon 
a given surface, will have nearly the same effect as one ounce rubbed 
in on the same surface; therefore, one ounce, to have double the ef- 
fect, should have double the surface. The quantity of ointment 
must therefore be adapted to the quantity of surface; for, on a cer- 
tain extent of surface, no more than a determined quantity of oint- 
ment can be applied so as to be absorbed; and applying a greater 



SECT. VI. OF THE LUES VENEREA. 329 

quantity would be useless; and if the quantity of surface is greater, 
the same portion of ointment cannot be diffused so as to employ fully 
all the absorbents. Every surface which is used may therefore have 
its full quantity of ointment, but certainly should not have more, if 
we are to attribute the effects of the mercury to the quantity. 

It has most probably been always the practice to rub the mercury 
well in, as it is termed; but I suspect that this arose rather from an 
idea of the surface being porous like a sponge, than of absorption 
being performed by the action of vessels; and it is probable, that this 
action in the vessels producing absorption may be rather disturbed 
than excited bv friction. 

How long the course is to be followed, is not to be exactly ascertain- 
ed- it may be thought proper to continue it till the local appearances, 
as 'nodes have subsided; but I suspect that this is hardly necessary, ex- 
cept thev sivc way readily: for in such cases, the local complamts or 
tumefaction, &c. generally require a longer time to be removed than 
the venereal action; and local applications must be of service, espe- 
cially if such tumefactions are obstinate. . 

The manner of living, under such a severe course, which is in 
everv respect weakening, is to be particularly attended to; the pa- 
tient must be supported; and the local effects of the medicine, in the 
mouth, preventing his taking any kinds of nourishment, especially 
Teh as are of a solid form, fluids must form his only nourishment, 
and these should be such as will become solid after they are swal- 
lowed; milk is of this kind. An egg beat up with a little sugar, and 
little wine; sago, salop, &c. form a proper diet. In many cases, 
w n ai 1 ha k mu'st be 1 given through the whole course. Sugar is 
perhaps, one of the best restoratives of any kmd we are acquai^ d 
with when a constitution has been very much debilitated b long 
fa in- from whatever cause, whether from the want of food when in 
held? or in the time of disease, or where the food has , not been a - 
lowed to answer the constitutional waste, as in a course o merenrj 
and when the disease, or course of mercury is gone then sugar will 
restore such constitution probably better than; in, h ing »*• 

Although it is not a common opinion, ^_^f^t! "ZZ 



fs a well-known fact, that all the negroes in the sugai „» . ■ „ « 

extremely lusty and fat ^^-^1^ 

live upon any thing else. The peases mid ca Ai ? 

feed upon them all become fat. The hair of me 

a R\ r( U who feed upon fruit never eat it till it Becomes veiy 

fine. Bi rds who leec up of and eyen 

npc, when it has f ™^dFtaB*wdh of sugar. Insects 

tX tame -W "/ «il J 5 longer Ltance of this fact 

,be Hooey is composed of sugar, with some other 

ju^es :of%o^ViA a little essential oil; but sugar is the principal 



SSO OF THE LUES VENEREA. CHAP, «L 

ingredient. When we consider that a swarm of bees will live a 
whole winter on a few pounds of honey, keep up a constant heat 
about ninety-five or ninety-six degrees, and the actions of the animal 
ceconomy e'qual to that heat, we must allow that sugar contains, per- 
haps, more real nourishment than any other known substance. 

We see too that whey is extremely fattening, which is the watery 
part of the milk, containing neither the oil, nor the coagulable mat- 
ter; this arises principally from the sugar it contains; for, being com- 
posed of the watery part, it holds all the sugar of the milk in solution. 
If the milk is allowed to become sour, it is not so fattening, because 
it is the sugar which is become sour. 

Although the nutritive qualities of sugar have not been so general- 
ly known as to introduce it into universal practice, yet they have not 
entirely escaped the notice of practitioners. Mr. Vaux, from observ- 
ing the negroes in the West Indies growing fat in the sugar season, 
has been induced to give it in very large quantities to many of his 
palients, and with very good effects. Honey is, perhaps, as good a 
mode of taking this substance as any: sweetening every thing that is 
either eat or drunk, whether by sugar in honey, or sugar alone, is 
probably immaterial; yet it is probable that the other ingredients in 
honey may add to its nutritive quality. 



These remarks on supporting the constitution must be attended to 
with great caution. It cannot be questioned that there are constitu- 
tions so irritable, as to render a mercurial course highly dangerous; 
and these must be supported by every possible means. In these 
there is no doubt that the mercurial action will be sufficient to su- 
persede the venereal; and there is even danger of the patient's life, 
from too high an excitement. But, in common cases, it is absurd to 
attend too closely to supporting the patient. A certain degree of ir- 
ritation must be produced, and every attempt at checking it by bark 
is not only useless, but protracts the cure, by lessening the suscepti- 
bility of the constitution to the effects of mercury. 

When the irritation is excited high enough to supersede the dis- 
ease, we cannot be too diligent in restoring our patient by everv 
means which will add to his strength, and lessen his irritability. 

It may be right to make one other remark in this place: though it 
is certain that a constitution, which has lately been under the influ- 
ence of mercury, is, for the most part, less susceptible of its impres- 
sion, yet there is a state in which, after very frequent courses, its sus- 
ceptibility is such, that it becomes dangerous to administer a quanti- 
ty, however minute, and in whatever form. It would appear as if 
the mercurial irritation had at length become so habitual, as to re- 
quire only the slightest stimulus for the constitution to fall into it 
In these cases, the brain generally suffers very considerably. There 
is a remarkable similarity in this respect, between the effect of ardent 



SECT - V11 - OF THE LUES VENEREA. 331 

spirits and mercury. To both we may be habituated to a certain 
degree; but, if carried beyond that, the consequence is, that the con- 
stitution cannot bear the slightest impression from either. 



SECTION VII. 

Of Local Treatment. 

If the local effects have gone no further than inflammation and 
swelling, either of the soft or hard parts, most probably no local treat- 
ment will be necessary; for the treatment of the constitution will, 
in general, remove them entirely. 

It sometimes, however, happens that the local complaints will not 
give way, but the parts remain swelled in an indolent and inactive 
state, even after there is every reason for supposing the constitution is 
perfectly cured. 

In such cases, the constitutional treatment is to be assisted by local 
applications of mercury to the part, either in the form of a plaster or 
ointment. The latter is by much the best mode. If these are not 
efficient, as often happens, we must endeavour to destroy this dis- 
position, by producing an inflammation of another kind. 1 have seen 
a venereal node which gave excruciating pain, cured by an incision 
only being made down to the bone, the whole length of the node; the 
pain has ceased, the swelling has decreased, and the sore healed up 
kindly, without the assistance of a grain of mercury. Blisters have 
been applied to nodes with success; they have removed the pains and 
diminished the swellings; so far furnishing a proof, that local treat- 
ment may assist mercury in many cases. 

This treatment has not only been used to assist mercury in those 
cases where the medicine did not appear to be equal to the disease, 
but it has been used at the commencement of the cure, and even be- 
fore mercury had been applied; but it was still thought necessary to 
go through the same mercurial course, as if nothing had been done to 
the local complaints. .... 

It mav be asked, what advantage arises from the incision, or ap- 
plication of the blister? The advantage is immediate relief from vio- 
lent pains; and, as there are two powers acting, it is natural to sup- 
pose the cure will be more speedy. . 

After all the above-mentioned trials, it may happen, that the local 
effects shall still remain, forming, as it were, a new disease, which 
mercury may increase; and therefore other methods of cure may be 
tried, as will be described hereafter. 



332 OF THE LUES VENEREA. CHAP. HI- 

SECTION VIII. 

Of Jlbscesses — Exfoliation. 

When an abscess forms in a node in the periosteum, the bones 
are generally affected and make part of the abscess. Great atten- 
tion should be paid to them; for suppurations in them are not like 
suppurations in common abscesses, they are seldom produced from 
the true suppurative inflammation, and therefore are slow in their 
progress, rarely producing true matter, but a mucus, something re- 
sembling slime, which lies flat upon the bone. This circumstance 
makes it difficult' to determine when suppuration has taken place, 
and, in many cases, to detect matter even where it is formed. Ano- 
ther circumstance, which renders the presence of matter in such 
cases doubtful, is, that the progress of the disease is generally check- 
ed very early by the use of mercury. This matter is often re-ab- 
sorbed during a mercurial course; and it is proper, particularly in 
an early state of the complaint, to give it this chance; but if the ab- 
sorption does not take place, and the complaint is in an advanced 
state, it must be opened. 

The surgical treatment of the parts, under such circumstances, is 
the same as in other diseases of these parts. Opening with great 
freedom is absolutely necessary; for, the more parts are exposed, the 
more inclinable they are in general to heal, and still more so here; 
for violence assists in destroying the venereal disposition. No skin, 
covering a bone, should be removed from an abscess, especially in 
the lower extremities. 

If the abscess is opened freely, and an exfoliation takes place, 
which is generally the case, it is to be treated as any other exfolia- 
tion. Exfoliations succeed much better here than in manv other 
cases, because the disease from which they proceed can generally be 
corrected, which is not the case in many diseases of bones where ex- 
foliation takes place. Cases, however, sometimes occur, in which 
after the venereal disposition has been corrected, another disease 
takes place in the bone, the nature of which will be explained when 
we shall consider the effects remaining after ihe disease is cured, and 
the diseases sometimes produced by the cure. 



iECT - X - OP THE LUES VENEREA. 333 

SECTION IX. 

Of Nodes on Tendons, Ligaments, and Fascia. 

The observations made on the nodes of the periosteum and bones 
are applicable to swellings and suppurations of the ligaments and 
fasciae; but it is still more difficult to ascertain the presence of mat- 
ter in them than in the former. 

When a thickening only of the ligaments or fascia? is the conse- 
quence of the disease, it is very obstinate, as in many cases the dis- 
eased part may be cleared of all venereal taint, and still the swell- 
ings remain. Blisters may often be applied here with success; but 
if they fail, then it will be absolutely necessary to make an incision 
into the part, to excite a more vigorous action; for although the 
complaint has nothing venereal in it, nor is any contamination to be 
feared from it in future, yet as it leaves often very obstinate and dis- 
agreeable swellings, which neither give way to medicine nor time, it 
is proper to use every means for their removal. 



SECTION X. 

Of correcting some of the Effects of Mercury. 

Formerly, when the management of mercury was not so well 
understood, nor its effects in this disease so well known as they are 
at present, it was generally supposed to act by evacuation from the 
salivary glands, and was therefore always given till that evacuation 
took place; and, as its effects in the cure were imagined to be in 
proportion to the quantity of this evacuation, it was pushed as far as 
possible, without endangering suffocation. From this treatment, it 
often happened in those constitutions which were very susceptible of 
the mercurial irritation, and in which the medicine produced much 
more violent effects on some particular secretions than could be wish- 
ed, that recourse was obliged to be had to medicines correcting the 
effects of mercury; as these effects were often a hinderance to its be- 
ing given in sufficient quantities for the cure of the disease. 

I mentioned, when treating of the effects of mercury, that the sen- 
sible increase of the secretions produced by it were in the following 
order: first, of saliva, then sweat, then urine, and often of the mucus 
of the intestines, producing purging: I also observed, that when any 
of those secretions became too violent, the hand of the surgeon was 



334 MF THE LUES VENEREA- CHAP. Ill- 

tied up till they were moderated. Attempts have been made to lessen 
those effects in two ways, either by the destruction of its power on 
the body in general, or by its removal, but neither of these means 
have succeeded. It never has once been thought necessary to at- 
tempt to lessen its powers on the organs of secretion, so as still to 
retain the same quantity in the constitution, or even to throw in 
more, which, if it couldbe effected, would be sometimes of great 
service; but, as we are not yet acquainted with powers sufficient for 
these purposes, we are obliged to observe great caution in our mode 
of giving the medicine. 

I have endeavoured to shew that this medicine need not be given 
with a view to procure those evacuations; and that it may be given 
in any quantity without increasing either of those secretions in any- 
evident degree; however, after every precaution, we may still be 
deceived, and the medicine will every now and then produce greater 
effects than were intended. It is very necessary, therefore, to seek 
for a preventive of the effects of mercury, when likely to be too vio- 
lent; or to remedy those effects when they have already taken 
place. 

The common practice, when mercury produced violent effects 
upon the intestines, was to counteract these effects; but this was not 
done with a view to retain the mercury in the constitution, but to 
relieve the bowels that were suffering by the action of the medicine; 
whereas, the proper practice would be to stop its progress here, 
as in every other outlet, that more mercury may be retained in the 
constitution. 

Although these increased secretions arise from the constitution 
being loaded with mercury, yet there is no danger in stopping them, 
for they do not arise from an universal disposition becoming a local 
or critical one; and therefore, if such an action be checked or stopped 
in one place, it must necessarily fall upon some other; but it is from 
the part being more susceptible of this irritation than any other, and 
the quantity now in the constitution being equal to the susceptibility 
of the part; and therefore, though its effects are stopped here, it does 
not break out any where else, every other part being capable of sup- 
porting this quantity, and of remaining unaffected till more is thrown 
in. 

When the mercury attacked the salivary glands, it increased that 
secretion so much, as in some cases to oblige practitioners to admi- 
nister such medicines as were thought likely to remove this new com- 
plaint. This susceptibility of the glands of the mouth, and the mouth 
in general, to be easily put into action by this medicine, was gene- 
rally supposed to arise from a scorbutic constitution, to which most 
complaints of the mouth are attributed. I am of opinion that scrofu- 
lous people, and those of a lax and delicate habit, are more subject 
to have it fall on the mouth, than those of a contrary temperament. 
Purges were given upon a supposition that mercury could be car- 



SECT. X. OF THE LUES VENEREA. 335 

ried off by the evacuation produced by them, and they were repeated 
according to the violence of the effects of the medicine, and the 
Strength of the patient: but I can hardly say that I ever have seen 
the effects of mercury upon the mouth lessened by purging; whether 
it arose spontaneously, was produced by purging medicines, or even 
when arising from the mercury itself. As this method was not found 
sufficient for the removal of the complaint, other medicines were 
tried; sulphur was supposed to be a specific for the removal of the 
effect of mercury. Whether this idea arose from practice or reason- 
ing, is not material ;* but I think I have seen good effects from it in 
some cases. If we can suppose purging of any service, purging with 
sulphur would answer best, as it would exert its effects both as a 
purge and a specific. 

Sulphur certainly enters the circulation as sulphur, because our 
sweat and urine smell of it; if it does not combine with the mercury, 
and destroy its properties as mercury, it is impossible, agreeable to 
the opinion of those who first thought of giving it with this intention, 
that it may so combine, as to form aethiop's mineral, or something 
similar; for we know that the aethiop's mineral, however formed, 
does not, in general, salivate. It is possible, too, that sulphur may 
act as a contrary stimulus to mercury, by counteracting the effects of 
it in the constitution. Sulphur has even been supposed to hinder the 
mercury from entering the circulation. Upon the whole, as these 
preparations of sulphur and mercury are still supposed to have good 
effects, and as I think I have seen good effects in other cases, we 
must either allow that they enter the circulation, or that their whole 
effects are on the stomach and intestines, with which the rest of the 
body sympathizes. The good effects from sulphur in lessening or 
altering the immediate effects of mercury, can only take place when 
that medicine is really in the constitution; therefore, a distinction is 
to be made between such as arise immediately from mercury, and 
one continued from habit, after the mercury has been evacuated from 
the constitution; a case that sometimes happens, and which will be 
taken notice of in its proper place. 

The taste in the mouth, from the use of mercury, has been known 
to go off, and not be perceived for a fortnight, and the same taste has 
recurred; this, I am informed, has happened twice to one gentleman, 
from the first quantity of mercury taken. To account for this is not 
easy ; in whatever way it happens, it is a curious fact. 

When the mercury has fallen upon the mouth and throat, washing 
those parts with opium has often good effects; for opium takes off irri- 
tability, and of course the soreness, which is one means of lessening 

* Sulnhur, united with any of the metals, probably destroys theirsolubility in 
theiuices or at least, their "effects in the circulation; none of the cinnabars act 
either as sulphur or mercury. Crude antimony, which is regulus and sulphur, 
h*a no effect Arsenic, when joined with sulphur, has no effect , nor has iron. 



336 OF THE LUES VENEREA. CHAP. III. 

the secretion. A drachm of tinctura thebaica to an ounce of water 
makes a good wash or gargle.* 

When the mercury falls upon the skin, it is neither so disagreeable 
nor so dangerous, as when it falls upon the mouth; however, it maj 
often happen that it will be proper to check such a discharge, both 
upon account of its being troublesome, and of its lessening the effects 
of the medicine in the constitution, by carrying it off. The bark is, 
perhaps, one of the best correctors of this increased secretion. 

When the medicine attacks the kidneys and increases the secretion 
of those glands, it is not so troublesome as when it produces sweating, 
though it is possible that it may carry off the mercury too soon; but, 
as we have but few medicines that can lessen that secretion, in most 
cases it must be allowed to go on. The bark may, in such cases, be 
given with advantage. 

When the mercury falls upon the bowels, it proves often more 
dangerous and troublesome than in any of the former cases, espe- 
cially the two last; but it is, perhaps, most in our power to prevent 
or palliate. Opium should be given in such quantities as to over- 
come the complaint, and I believe will seldom fail of removing all the 
symptoms. 



SECTION XI. 

Of the Form of the different Preparations of Mercury when in the 
Circulation. 

It would appear, from reason and many circumstances, that mer- 
cury must be in the state of solution in the juices of the body, before 
it can act upon the venereal disease; and, indeed, before it can act 
upon any other disease. That mercury is in a state of solution in 
our juices, and not in the state of any preparation of mercury, that we 
know of, is very probable from the following facts: 

First, crude mercury, every salt of mercury, and calx of mercury, 
is soluble in the spittle, when taken into the mouth, by which means 
it is rendered sensible to the taste; from thence it must appear, that it 
is capable of solution in some of our juices. 

Secondly, crude mercury, when divided into small parts by gum 
arable, &c. so as to be easier of solution when taken into the sto- 

* My using opium in this way was from analogy; finding that opium quieted 
the bowels when a purging came on in consequence of mercury, I tried it bv 

th<?s J^t t0 ? £ T U \ "J? f ° U , nd S° od efi ' ects from *» b «t «»t equal to 
thoie which it produced m the bowels. * 



3ECT. XI. OF THE LUES VENEREA. 337 

mach, generally purges; but crude mercury, taken without such divi- 
sion, has no such powers, not being so readily dissolved in the juices 
of the stomach. The simple calx of mercury has the same effects, — 
purging; and much more violently, from being, I suppose, readier of 
solution in the animal juices; for, if it only purged from its union with 
the acid which happened to be in the stomach, it most probably would 
not purge more than crude mercury; although it is very probable, 
that the calx is easier of solution in a weak acid, than even the crude 
mercury. 

Thirdly, every preparation of mercury producing the same effect 
in the mouth, and also having one and the same effect in the consti- 
tution, shows that they must all undergo a change by which they are 
reduced to one particular form. We cannot say what that form is, 
whether it is the calx, the metal, or any other that we are acquainted 
with; but it is probable that it is not any of them, but a new solution 
in the animal juices, peculiar to the animal itself. This is rendered 
still more probable by this circumstance, that every preparation of 
mercury put into the mouth undergoes the same change, and the 
spittle has the same taste from everyone of them. If every differ- 
ent preparation of mercury had the same properties in the constitu- 
tion that it possesses out of it, which we must suppose if it enters and 
continues in the same form, in that case the venereal poison must be 
eradicated in as many different ways as there are preparations. 
Crude mercury would act mechanically, by increasing the weight 
and momentum of the blood; the calx would act like brickdust or 
any other powder that is heavy; the red precipitate would stimulate 
by chymical properties in one way, while the corrosive sublimate 
would act in another, and the mercurius flavus in a third; this last 
would most probably vomit as ipecacuanha does, winch vomits whe- 
ther thrown into the stomach or circulation. . 

Fourthly, all the preparations of mercury, when locally applied, 
act always in one way, that is, as mercury; but some have also ano- 
ther mode of action, which is chymical, and which is according to the 
specific nature of the preparation. The red precipitate ,s a prepara- 
tion of this kind, and acts in both these ways; it is either a stimulant 
or an escharotic. . , . 

To ascertain whether this opinion of mercury being in solution in 
our juices was just, I made the following experiments upon myself. 
T put some crude mercury into my mouth, as a standard and let it 
stav there working it about, so as to render it easier of solution, till 1 
tasted it sensibly; I then put into my mouth the mercurius calcinatus, 
and let it remain till I perceived the taste of it, which was exactly 
the same- but J observed that it was easier of solution than the crude 
mercurv ' I tried calomel in the same way, and also corrosive subli- 
mate a^er being diluted with water, and the taste was still the same. 
U was ome time before I perceived the taste of the crude mercury 
n my mouth I tasted the calx and calomel much sooner. The 



V 11 



33S OP THE LUES VENEREA^ CHAP. III. 

corrosive sublimate had at first a mixed taste, but when the acid 
was diluted it had exactly the same taste with the former; all 
these different preparations producing the same sensation or taste in 
the mouth. 

From the effects of these experiments it would appear, that the 
mercury in every one of them was dissolved in the spittle, and reduc- 
ed to the same preparation or solution. 

To try whether mercury in the constitution would produce the same 
taste in the mouth, I rubbed in mercurial ointment upon my thighs 
till my mouth was affected, and I could plainly taste the mercury; 
and, as far as I could rely upon my memory, the taste was exactly 
the same as in the former experiments. 

I allowed some time for my mouth to get perfectly well and free 
from the taste; I then took calomel in pilis till it was affected again 
in the same way. I afterwards took mercurius calcinatus, and also 
corrosive sublimate. All these experiments were attended with the 
same result; the mercury in every form producing the same taste, 
which was also exactly the same as when the several preparations 
were put into the mouth. 

From the above experiments it must appear, that when mercury 
produces evacuation by the mouth, it certainly goes off in that dis- 
charge; and from thence we may reasonably conclude, that when 
other evacuations are produced from the medicine, when in the con- 
stitution, as purging, sweating, or an increased flow of urine, that 
it also goes off by these evacuations, which become outlets to the 
mercury. 

From the above experiments, it appears to be immaterial what 
preparation of mercury is used in the cure of this disease, provided 
it is of easy solution in our juices, the preparations easiest of solution 
being always the best. 



SECTION XII. 

Of the Operation of Mercury on the Poison. 

Mercury may be supposed to act in three different ways in cur- 
ing the venereal disease. First, it may unite with the poison chy- 
mically, and decompose it, by which means its powers of irritation 
may be destroyed; secondly, it may carry it out of the constitution by 
evacuation; or thirdly, it may produce an irritation-in the constitution 
which counteracts the venereal, and entirely destroys it. 

It has been supposed that mercury acts simply by its weight in the 
circulating fluids; but of this we can form no adequate idea; and if it 



SECT. XII. OF THE LUES VENEREA. 339 

were so, oilier substances should act on this disease in proportion to 
their weight, and of course many of them should cure it; but from ex- 
perience we find, that such bodies as have considerable weight, as 
most of the metals, have no effect on this disease. We have no proof 
of mercury acting by a decomposition of the poison from any of the 
concomitant circumstances. 

Mercury certainly does not cure the venereal disease by uniting 
with the poison and producing an evacuation. For in those cases 
where mercury is given in such a way as to produce considerable 
evacuations, or in those constitutions where evacuations are easily ex- 
cited by mercury, its effects upon the diseased action are the least; 
and the same evacuations produced by any other means have not the 
least effect on the disease. 

Whether the mercury be supposed to carry off the circulating poi- 
son, or to decompose it, in neither way could it produce, when lo- 
cally applied, any effect on a venereal inflammation or sore arising 
from the constitution; for as long as any of the poison existed in the 
circulation, none of them could be healed by local applications, the 
circulation constantly carrying the poison to them; but we find the 
contrary of this to be true; for a venereal sore, arising from the con- 
stitution, may be cured locally. 

The last or third of our modes of action of mercury seems to me 
the most probable, and for many reasons; first, because the disease 
can in many cases be cured by raising a violent stimulus of another 
kind; and perhaps if we could raise such a constitutional irritation 
without danger, as we often can in local cases, we might cure the 
venereal disease in the same manner, and in one quarter of the usual 
time. Secondly, we find that mercury acts as an universal stimulus, 
causing great irritability in the constitution, making the heart beat 
faster, and rendering the arteries more rigid, so as to produce a hard 
pulse, as has been already observed. It may further be said to pro- 
duce a disease, or a peculiar or unnatural mode of action, in a certain 
degree. The following case will illustrate this. A gentleman had 
electricity recommended to him for some complaint he had The 
electricity was applied, but without any visible effect. Besides the 
complaint for which he used electricity, he had a venereal one, for 
which he was first put under a course of mercury, and while under 
it the electricity was applied for the former complaint; but he had 
become so irritable that he could not bear the shocks of one halt then- 
former strength. But the most curious part of the case was, that the 
shocks had a much greater effect on the disease than what they had 
before when twice as strong, and he now got cured. This gave the 
sin-eon a hint, and having another occasion to use electricity, also 
without effect, he put the patient under a gentle course of mercury, 
and then found the same effects from the electricity as in the former 
case, and the patient also got well. 

The powers of mercury upon the constitution appear to be as the 



340 OF THE LUES VENEREA. CHAP. III. 

quantity of mercury and the susceptibility of the constitution to be 
affected with it, without any relation to the disease itself; and we 
find that the power of mercury upon the disease is nearly in the same 
proportion. This fact gives us an idea of the irritation of mercury 
upon the constitution, and consequently an idea of administering it r 
and of the cure of any disease for which it is a remedy. 

As we find that a given quantity of mercury produces double ef- 
fects in some constitutions to what it does in others; also, that in 
those cases it produces its effects upon the disease, we are led to be- 
lieve that it is this effect upon the constitution which cures the dis- 
ease; and therefore if it did not produce this effect it would also not 
have performed a cure. I have already observed, that the cure does 
not go on exactly in proportion to the visible effects upon the consti- 
tution, except quantity in the medicine is joined with it; which, if 
true, would incline us to believe that there was something more than 
simply a constitutional stimulus, which most probably is a peculiar 
specific effect which is not regulated entirely by its visible effects 
either constitutional or local, although they appear to have some con- 
nection. 

This fact being known, obliges us to be more liberal in giving 
mercury in those constitutions where it makes but little impression, 
than in those which it easily irritates; although in these last we must 
not be entirely regulated by its local effects, nor depend upon a com- 
monly sufficient quantity, but be ruled by the sensibility of the con- 
stitution, and quantity joined; for in those where the constitution ap- 
pears to be very susceptible of the mercurial irritation, where small 
quantities produce considerable local effects, it is still necessary to 
have quantity, although it is not so necessary to take the quantity in 
general that is supposed to be sufficient. We must be guided by the 
three following circumstances:— the disappearance of the disease, the 
quantity of irritation produced, and the quantity of the medicine 
taken. 



SECTION XIII. 

Of Gum Guaiacum and Radix Sarsaparilla in the Venereal Disease. 

I have hitherto only recommended mercury in the cure of the ve- 
nereal disease; and indeed it is the only medicine to be depended 
upon. However, as both the guaiacum and sarsaparilla have been 
recommended as powerful remedies in this complaint, 1 took a fa- 
vourable opportunity of trying their comparative powers in the vene- 
real disease upon the same person. 



SECT. XII. OF THE LUES VENEREA. 341 

The guaiacum* I found had considerable specific power over the 
disease; consequently, it may be of service in slight cases where it 
may be inconvenient or improper to give mercury on account of some 
other disease. These cases, however, I have not yet ascertained; or, 
it may be given in those cases where it is apprehended that the quan- 
tity of mercury necessary to subdue the disease, would be too much 
for the constitution to bear; — cases which sometimes occur. The 
sarsaparilla appeared to have no effect at all. 

I shall relate exactly the case in which their comparative powers 
were tried. A man came into St. George's Hospital with venereal 
sores over almost his whole body: there were many excrescent sores 
in the armpits, some of which were about the size of a halfpenny; 
there were the same appearances about the anus, between the but- 
tocks, along the perinaeum, between the scrotum and thigh, where 
those parts came in contact with one another. Those upon the skin 
in general had the common appearance. I ordered a poultice of the 
gum guaiacum to be applied to the sores in the right armpit; also a 
poultice of a strong decoction of sarsaparilla and oatmeal mixed, to 
be applied to the left armpit. These poultices were changed every 
day for a fortnight; the excrescent sores in the right armpit were 
entirely healed, and become even with the skin, and covered with 
a natural skin, although somewhat discoloured; the sores in the 
left armpit, which were poulticed with sarsaparilla, were rather worse 
than when the poultice was first applied, as indeed were all the 
sores, except those in the right armpit. I then ordered the poultice ol 
<niaiacum to be applied to the left armpit, which was done, and the 
sores there also got well in a fortnight; I was now perfectly convinced 
that the gum guaiacum had cured these eruptions locally. 

I next wished to see what effect the gum guaiacum would have 
upon the remaining sores when given internally, that is, those about 
the anus, scrotum, and on the skin in general. The patient began 
with half a drachm three times every day, which purged him; but 
this was prevented by joining it with opium. In about four weeks 
all the eruptions were cured, and he was allowed to stay in the hospi- 
tal some time longer, to see if he would continue well; but about a 
fortnight after, he began to break out anew, and in a very short time 
was almost as bad as ever. I began a second time the gum guaiacum 
internally: but it had lost all its powers, or rather, the constitution 
was no longer affected by it. He was put under a course of mercu- 
ry, and cured. 

* The lienum K uaiaci was imported by tl.e Spaniards from Ilispaniola, as a 

cure for HE disease, '" *■ J« 1517 ' havin « b ^ S " tD l ° ° nC ° f 
them by a native. 



<:}[> OF THE LUES VENEREA. .HAP. IV. 



CHAP. IV. 

Of th£ Effects remaining after the Disease is cured, and oj tlie Dis- 
eases sometimes produced by the Cure. 

In treating of the local effects of the venereal disease, the gonor- 
rhoea, and chancre, as also the bubo, I observed, that after the virus 
was destroyed, there remained in many cases some of the same symp- 
toms, and particularly after the gonorrhoea. It was also observed, 
that though all the symptoms were entirely cured, yet they were lia- 
ble to break out again. A gleet will appear, sometimes attended with 
pain, so as to resemble a gonorrhoea; after chancres there will be 
sores resembling them; and buboes after the virus is gone will not 
heal, but spread. In the lues venerea, the same thing often happens; 
especially if the inflammation and suppuration have been violent in 
the parts. These cases puzzle considerably; for it is difficult to say 
when the venereal virus is absolutely gone. In such doubtful cases, 
the treatment to be followed becomes more undetermined. 

Such complaints are more common in the tonsils than in any other 
part; for we often find, that while a mercurial course is going on, 
and the ulcer on the tonsils healing, or even healed, they shall swell, 
become excoriated, and the excoriations shall sometimes spread over 
the whole palatum molle, which renders the nature of the disease 
doubtful. I believe these excoriations, as well as such other appear- 
ances of disease as come on during the use of mercury, are seldom or 
never venereal. In all such cases, I would recommend not to con- 
tinue the mercury longer than what appeal's sufficient for overcoming 
the original venereal complaints, not considering those changes in the 
case as venereal. The bark is often of service here, and may be 
given either with the mercury, or after the mercurial course is over. 

It of.en happens that venereal abscesses will not heal up, although 
they have gone a ceYtain length towards it; for, while the venereal 
action remained in the part, the mercury disposed that part to heal; 
but, under that course, the constitution and part had acquired another 
disposition, proceeding from a venereal and mercurial irritation af- 
fecting a particular habit of body, or part, at the time; which new 
disposition differs from the venereal, mercurial, and natural, being a 
fourth disposition arising out of all the three. I suspect, however, 
that it depends chiefly on the constitution; because, if it was owing 
to the other two, we should always have the same disease; and what 
makes this opinion more probable is, that it differs in different peo- 
ple; at least, it is not cured in all by the same means. The consti- 
tution being predisposed, the other two become the immediate causes 



CIIAP - Iv - OF THE LUES VENEREA. Si3 

of action. As soon as the venereal irritation is destroyed by the 
mercury, or becomes weaker than the other two, then the effects of 
the others take place. While the venereal action prevails, the mer- 
cury is of service, and the sore continues healing; but, when it is 
lessened to a certain degree, or destroyed, the mercury not only loses 
its powers, but becomes a poison to the new disposition that is form- 
ed; for, if mercury is continued, the sore spreads: it should, there- 
fore, be immediately left off. 

Some of the sores, formed in this way, not only resist all means of 
cure, but often inflame, ulcerate, and form hard callous bases, so as 
to put on the appearance of a cancer, and are often supposed really 
to be so. 

We find, also, that new diseases arise from the mercury alone. 
The tonsils shall swell where no venereal disease has been before; 
the periosteum shall thicken, and also probably the bones, and the 
parts over them shall become oedematous and sore to the touch; but 
as these complaints arise while under a mercurial course, they are 
not to be reckoned venereal, but a new disease, although they are too 
often supposed to be venereal, and on that account the mercury is 
pushed as far as possible. In such cases, if the complaints for which 
the mercury was given are nearly cured, and the medicine has been 
continued a sufficient time after to complete the cure of those com- 
plaints, then of course it should be left off; and if there be any 
doubt, it should be left off rather sooner, than if no such complaint 
had taken place; because, it is probably producing a worse disease 
than the venereal; and if, after the cure of these complaints from 
the mercury, the venereal disease begins again to come into action, 
mercury must be given a second time; and now the constitution will 
be better able to bear it, especially if attention has been paid to the 
restoring the strength of it. Those diseases of the tonsils and peri- 
osteum I suspect to be of scrofulous origin. 

Besides local complaints, arising from the combined action of the 
mercury, the disease, and the constitution, there is sometimes a con- 
stitutional effect, which is, a weakness, or debility, a languor, want of 
appetite, frequent sweats threatening hectic; but these happen mostly 
in those constitutions with which mercury disagrees. These com- 
plaints, local as well as constitutional, arise in some measure from 
weakness. They are difficult of cure, whether arising from a vene- 
real chancre, bubo, or the lues venerea. Strengthening medicines 
are of most service: the bark is of great use, though in general not 
sufficient, as it can only more or less remove the weakness, the spe- 
cific qualities still remaining. What these are, is, I believe, not yet 
known; but I suspect that many partake of the scrofula; and this 
opinion is strengthened by their frequently giving way to sea-bath- 
ing.* 

* In a case of an ulcerated rib from a venereal cause, and five nodes on the 
shin hone,' of twelve months standing, a deep salivation of six months svas un- 



344 OF THE Ll)ES VENEREA. CHAP. IV. 

SECTION I. 

General Observations on the Medicines usually given for the Cure. 

A decoction of the woods, among which are commonly included 
guaiacum and sarsaparilla, is one of the first medicines in the cure, 
and many of the cases yield to it, which gives them the credit of 
curing the venereal disease, while such diseases were supposed to be 
venereal. The sarsaparilla was often given alone, and was found to 
produce nearly the same effect. The good effects of it in one case 
gave it some reputation.* A diet-drink discovered at Lisbon was 
also of considerable service: and as it cured cases similar to those 
cured by the sarsaparilla, it was imagined that the diet-drink consist- 
ed principally of a decoction of this root. This was still on the 
supposition that all those cases were venereal; but it was observed at 
last, that those medicines did not cure this disease till mercury had 
been given, and in a tolerably large quantity. This was sufficient to 
lead some thinking minds to doubt whether they were venereal or 
not; and their being cured by different medicines ought to produce a 
conviction of their being different from the venereal disease, and that 
they are themselves of different kinds. 

The mezereon has also been found to be of service in some symp- 
toms of the lues venerea, such as nodes of the bones; but their being 
venereal was taken for granted. The mezereon is seldom given in 
venereal ulcers in the throat, or blotches on the skin, which of all the 
venereal symptoms are the most certain, and the most easy of cure; 
yet it was conceived that it removed such symptoms as are the most 
difficult of cure: but all those cases, in which the mezereon has 
been given with success, plainly appear not to have been venereal. 

When the hemlock came into fashion in this country, it was given 
in almost every disease, and of course was tried in "some of those 
complaints consequent to the venereal disease; and some of these ii 
was found to cure, so that it now stands upon the list of remedies. 
Velno's vegetable syrup has had similar effects in some of these cases; 
and opium appears also to have many advocates. Opium, like the 
sarsaparilla, and mezereon, was supposed by its first introducers to 
cure the lues venerea;! but, like the sarsaparilla, it appears to have no 

dergone, after fruitless attempts by gentle friction. None of the sores were 
healed by the mercury, and the patient was ordered to bathe in the sea, and 
take the bark. In three orfour months the sores all healed up Very kindly: but 
the side last of all. J 

*Jt?£ " Lonclon Medical Essays," a case published by Mr. Fordyce, now 
Sir A\ llham Fordyce. 

f See " Medical Communications," vol. I. page 307. 



SECT - '• OF THE LUES VENEREA. 345 

effect till mercury has done its best, or its worst* It has certainly 
considerable effects in many diseases, both in such as are conse- 
quent to the venereal disease, and otbers arising from other causes. 

It has been long a favourite medicine of mine, not only as reliev- 
ing pain, for that is its common effect, but as a medicine capable of 
altering diseased actions, and producing healthy ones. In all sores 
attended with irritability, a decoction of poppy heads, made into a 
poultice, is an excellent application. Bleeding sores that do not arise 
from weakness, but from irritability, have the bleeding stopped im- 
mediately by this application. Mr. Pott is, I believe, the first who 
showed the world its use in mortifications. My first mode of apply- 
ing it for the cure of diseases was locally, in which I found it had 
most salutary effects in some cases, and it was ordered afterwards in- 
ternally upon the same principle, and it was also found to have salu- 
tary effects in this mode. In two cases that had been long suspect- 
ed to be venereal, its effects were very remarkable; and, by its Lav- 
ing cured them, it confirmed me in my opinion that they were not. 
But when I was informed that they cured the venereal disease in the 
army in America by opium, I then began to question myself, whe- 
ther I had formed a right judgment of the nature of those two cases 
which were cured by opium. To ascertain whether opium would 
cure the lues venerea or not, I made the following trial at St. George's 
Hospital : 

A woman was taken into the hospital with blotches on her skin, 
which had arrived to the state of scabs, and with well-marked vene- 
real ulcers on both tonsils. A grain of opium was ordered to be 
taken the first night, two the second, and so on, increasing a grain 
every night, unless something should arise to forbid it. This was 
closely followed till the nineteenth night, when she was ordered a 
dose of physic, as she had become costive, and the opium was omit- 
ted. On the 20th she began again, and continued increasing the 
dose, as before, till it amounted to thirty grains, no alteration being 
produced in the sores, except what arose from the loss of time, 
whereby they were rather worse. I concluded, that if she had taken 
mercury to affect the constitution as much as the opium did, the vene- 
real disease must have been nearly curefl, or, at least, much lessen- 
ed- but, as that was not the case, it convinced me that the opium had 
no'effect whatever on the venereal disease. I then put her under a 
course of mercury, by friction, and in a short time it affected her 
mouth; the sores 'soon began to look better, and they went on healing 
without interruption, till the disease was cured. I may justly ob- 
serve, the inconvenience from the opium was not considerable; for 
although it kept her quiet, she was not constantly dosing 

Luke Ward was admitted into St Bartholomew's Hospital, January 
12, 1785; his complaint was an ulcer in the throat of three months 

• See a pamphlet published by Mr. Grant 
\ X 



346 



OF THE LUES VENEREA, CHAP. IV. 



standing, which, both from its appearance and the symptoms which 
preceded it, seemed to be venereal. He was ordered two grains of 
opium twice a ^ ^^ ^,fe^ ^ ^^^o^- 



feet than that of sleeping better at night than usual, when the dose 
was increased to two grains three times a day. His throat now gave 
him less pain; but upon inspection was not found to be at all mended. 
After two days the dose was increased to three grains thrice a day; 
from this quantity he felt little or no inconvenience: he complained 
of being a little drowsy; his eyes were rather inflamed and his lace 
rather flushed. He continued to take this quantity for five days, and 
then it was increased to three grains four times a day. Next morn- 
ing the redness and heat of his face was much increased, and had 
extended over his whole skin; he complained of pain in his head. 
His pulse was full and strong; he was bound in his body, and his 
belly was tense and painful. The opium was omitted, and such re- 
medies as the present symptoms seemed to require were given, but 
without effect; all his symptoms continuing to increase till he died, 
which was on the fourth day after; during this time the ulcer increas- 
ed much, and the discharge of saliva was so great as to resemble a 
slight salivation. 

This case proves, in the first place, that the opium had no effect 
upon the ulcer in the throat; and, in the next, that it is a medicine 
capable of producing very violent effects on the skin, requiring there- 
fore great caution in the mode of administering it. 

John Morgan was admitted into St. Bartholomew's Hospital with 
an ulcerated leg. The common applications were tried for seven 
weeks, at the end of which time he was in every respect worse, hav- 
ing no sleep from constant pain, and he was sinking very fast. Two 
grains of opium were given every two hours, for twenty-three days; 
it made him hot and costive, and his pulse became strong and full, 
but without sleep or abatement of pain. The dose was increased to 
four grains every two hours in the day, and eight grains every two 
hours during the night. The effects were, costiveness, retention of 
urine, loss of appetite, an inflammatory disposition, no sleep, without 
any amendment of the ulcer. On the third day of taking the last- 
mentioned quantities, he awoke from a short sleep, delirious, and 
continued so for twelve hours, when it left him very weak, sick at 
his stomach, and with a low pulse. In three or four hours the de- 
lirium returned, and continued forty-eight hours; the pulse, on its 
return, immediately rose, and his strength returned to a very great 
degree. When it went off he fell into a sound sleep for about eight 
hours, and awoke very tranquil, though weak; no more opium was 
given, and the leg in the space of a month healed. 

In the first twenty-three days he took twenty-four grains a day; 
for the last three days he took seventy-two grains a day. In twenty- 
six days he took seven hundred and sixty eight, which is nearly two 
ounces of opium. 



SECT. II. OF THE LUES VENEREA. 347 

Sarsaparilla, from the comparative experiment made with it and 
the guaiacum, it would appear to have no effect upon the venereal 
irritation itself, and therefore can be of no service till that irritation 
is destroyed; and as mercury is the antidote to that poison, and be- 
comes one of the causes of the complaints in which sarsaparilla is 
useful, therefore, mercury is not only necessary to destroy the poison, 
but also assists in forming the diseases we are now treating of. 

It is easy to conceive it in many cases to be of use in preventing 
the formation of the disease arising from mercury. When given 
along with the mercury it is often joined with the gum guaiacum, or 
the wood of the guaiacum, which we know will have some effect. 

The sarsaparilla is generally given in form of a decoction, three 
ounces to three pints of water, boiled down slowly to a quart, and the 
half or whole is drunk every day, generally at three different times, 
often at meals. It is sometimes ground to a powder and taken every 
day with the same effect; but I should prefer the extract made into 
pills, as the easiest way of taking this medicine. 

In many of these cases I have seen good effects from the hem- 
lock, of which the following is an instance; and I would further 
refer the reader back to my observations on this medicine, which 
I gave when treating of the 'disease produced in consequence of a 
bubo, page 261. . 

A poor woman had undergone repeated salivations, which had 
always relieved the most pressing symptoms; but after that she was 
afflicted more or loss for three or four years, ulcers broke out in her 
nose and all over her face, with what is called a true cancerous ap- 
pearance. The sores became soon very deep, and gave very consi- 
derable pain. Mercury, sarsaparilla, and bark were given, without 
effect- the sores getting daily worse, the parts affected were ordered 
to be held over the steam of a decoction of hemlock every four hours, 
and as much extract to be taken internally as the patient could bear. 
She had sleep, and was free from pain the first night; and in a few 
davs the sores put on a healing appearance. She lost her nose and 
one side of her mouth; but in six weeks time every part was skinned 
over. She remained well for three months, when the disease return- 
ed with redoubled violence, and soon destroyed her. 



SECTION II. 

Of the Continuance of the Spitting. 

It sometimes happens that the spitting cogues after there is 
.very reason for supposing the mercury to be entirely out of the con- 



34# OF THE LUES VENEREA. CHAP. V. 

stitution. As it is only a continuation of an action, or an effect of 
mercury having been in the constitution, it is necessary to distinguish 
it from the original, or from the immediate effect of mercury; since on 
this distinction rests the method of cure. Such constitutions have 
been generally supposed scorbutic; and where there is a great sus- 
ceptibility of the mercurial stimulus in these parts, the salivation 
will continue for months after the mercury has been completely re- 
moved; but this medicine not being given now in quantity sufficient 
to produce such violent effects on the salivary glands, these cases 
seldom occur. 

In such cases I would recommend strengthening diet, and strength- 
ening medicines. Sea-bathing is one of the best restoratives of re- 
laxed habits, especially after mercury. Mead's tincture of cantha- 
rides is supposed to be of service in those cases. 

The alveolar processes have sometimes become dead, and ex- 
foliations have taken place; and this alone has kept up a dis- 
charge of saliva. When this happens, we must wait till separation 
takes place, and extract the loose pieces, after which the salivation 
will subside. 

I have seen part of the jaw exfoliate from this cause. In most 
cases the teeth become loose; and in many they drop out. 



CHAP. V. 

Of preventing the Venereal Disease. 

As diseases in general should not only be cured, but, when it is 
possible prevented, it will not be improper to show, as far as we 
know, how that may be done; for in this disease we can with more 
certainty prevent infection, its origin being known. 

Preventives are previous or immediate applications, as may be 
divided into various kinds; as those that will not allow the venereal 
matter to come in contact with the parts; those which wash it off be- 
thels?™ 5 ^ ^^ Wl " Ch "^ &Ct ch ? micall y a » d destroy 

tat rUb , bed T a dry part stick t0 *> and P^ent any thing 
real P oisTi7 ^ C T ng hl C ° ntaCt With * and as the vene? 
the p^T miXCd Wlth a Water >" fluid ' k is not a »™ed to touch 

ter E J n 7remoLt!t h f haS l V °™ ° f "l™* with the Venereal ^ 

with the matter formL ' ft f ° r thlS P Ur P ose ' lt unites 

er ' Iormn/ I a soap, and is then easily washed off. 



CHAP. V. OP THE LUES VENEREA. 349 

It is possible this union with the alkali may destroy the poison: the 
alkali must be much diluted, or it will excoriate. 

Lime-water would make a good wash. 

If both these methods were put in practice, there would be still 
more security. 

Corrosive sublimate in water, about a grain or two to eight ounces, 
has been known to prevent the catching of the disease. 



350 OF DISEASES RESEMBLING 



PART VII. 



OF DISEASES RESEMBLING THE LUES VENEREA, WHICH HAVE BEEN 
MISTAKEN FOR IT. 

It was reserved for the penetrating mind of John Hunter, to make 
the first disclosure of all the arcana contained in the subsequent 
chapter. That he did no more is less surprising than that he did so 
much. The man who had ascertained the laws of the venereal dis- 
ease, and every possible variety occasioned by whatever cause, 
through its progress and cure, could alone account for certain appear- 
ances which, in every stage, and in the means of cure, differed from 
that disease; and which we should take shame to ourselves for hav- 
ing confounded with it on the mere coincidence of a few events. My 
contemporaries must recollect the astonishment with which we heard, 
that Mr. Hunter could question, (for, at that time, we thought it un- 
necessary to question,) whether a disease received from another per- 
son producing a local ulcer, and, after a certain time, copper spots in 
different parts of the skin, whether such a disease was venereal. 
None of us thought it necessary to inquire, whether the first local ul- 
cer had the true venereal character, why, in some instances, the whole 
should pass off without mercury? or why, in others, mercury should 
be useless or even injurious? 

Whether Mr. Hunter ever conceived the idea of reducing these 
diseases to any order, cannot now be ascertained. Such an attempt 
did not make a necessary part of his work. It was, indeed, pro- 
ceeding a great way, to describe accurately so many cases, and to 
show in what they each differed from the venereal character. Being 
the first writer who followed this inquiry, I am perhaps the fittest to 
ascertain how much he has instructed us in the mode of conducting 
it, which is all that he professed to do. Since the first edition of 
" Morbid Poisons," the controversy concerning the cure of syphilis 
by acids has convinced many of the necessity of accurately ascer- 
taining a disease, before they determine on the effects of a remedy. 
Mr. Abernethy has added some valuable cases. Of all these I have 
availed myself in a second edition. Beside the anomalous morbid 
poisons, which have been confounded with the venereal, having had 
the opportunity of tracing two (yaws and sivvens) which are re- 
ducible to certain laws, I trust, the inquiry is now in that state in 



CHAP - *• THE LUES VENEREA. 351 

which every new fact will find its proper place, and add to our know- 
ledge. All that has occurred to me being already before the public, 
I shall, in this place, offer a very few remarks. 

In all diseases in those parts in Avhich we have reason to suspect 
the first symptoms of the venereal disease, our business is to trace, 
if possible, that peculiar character of the chancre, so accurately de- 
scribed by Mr. Hunter. When we are satisfied of this, we cannot 
too soon begin our mercurial course. If this character should not 
appear, we are to consider first, that a mercurial course is by no 
means a matter of indifference; next, that there are diseases in those 
as well as other parts, which are exasperated by mercury; and, last- 
ly, that there are morbid poisons which must run a certain course, 
before they can be cured; that if that course is not rapid, it may be 
suspended by mercury, but that this suspension is worse than useless; 
the constitution is reduced, and the character of the disease so chang- 
ed, that we can no longer ascertain what would have been its appear- 
ance had no mercury been used. This last is illustrated by yaws, as 
may be seen in every accurate writer on that disease. In all such 
cases, therefore, irreparable mischief is often done by a hasty appli- 
cation to mercury. 

Lastly, there are others, which, though not venereal, will yield to 
no remedy or to none with so much certainty as mercury. These 
are for the most part easily distinguished by the rapidity of the ulcer- 
ation, and the readiness with which it is stopped by a very slight ex- 
hibition of the remedy. Of this kind is the sivvens of Scotland. 

The conclusion is, that when we perceive the hard edge and base 
of the chancre, we should apply to the specific immediately: but in all 
other cases, unless the ulceration is rapid, we should suspend the use 
of this important remedy, till we discover, as far as it can be disco- 
vered. the character of the disease. 



CHAP. I 



Of Diseases resembling the Lues Venerea, which have been mistaken 

for it. 

There is probably no one disease to which some other may not 
bear a strong resemblance in some of its appearances or symptoms, 
whereby they may be mistaken for each other. The situation of a 
complaint also may mislead the judgment. A lump, for instance, in 
the breast of a woman, may resemble a cancer so much as to be 
mistaken for one, if all the distinguishing marks of cancer are not 
well attended to. An ulcer on the glans penis, or in the throat, and 
nose creates a suspicion of the venereal disrase. Even the way in 



352 OF DISEASES RESEMBLING CHAP, t 

which a disease is caught, becomes a cause of suspicion. The fluor 
albus in women sometimes produces a simple gonorrhoea in men. 
Drinking out of the same cup with a venereal patient was formerly 
supposed to be capable of communicating the lues venerea; but this 
notion is, I believe, now exploded. Of late years, a new mode of 
producing the venereal disease is supposed to have arisen; this is by 
the transplanting of a tooth, from the mouth of one person into the 
mouth of another. That such practice has produced diseases is un- 
doubted; but how far it has been venereal remains to be considered. 

Diseases which resemble others, seldom do it in more than one or 
two of the symptoms; therefore, whenever the nature of the disease 
is suspected, the whole of the symptoms should be well investigated, 
to see whether it agrees, in all of them, with the disease it is suspect- 
ed to be, or only in part. This observation seems to be more appli- 
cable to the venereal disease, than any other; for there is hardly any 
disorder that has more diseases resembling it in all its different forms 
than the venereal disease: and when a disease resembles the vene- 
real in some of its symptoms, but not at all in others, then 
those other symptoms are to be set down as the specific, or lead- 
ing ones of the disease to which it belongs; the resembling symp- 
toms to the venereal being only the common ones. But, if a 
disease is suspected to be venereal, though it is not perfectly marked, 
yet if it resembles the venereal in most of its symptoms, it must be 
supposed to be venereal, that being the most probable, although it is 
by no means certain; for, probably, the venereal can hardly be demon- 
strated in any case, especially in the form of the lues venerea, from 
its not having the power of contamination. 

Although the venereal disease keeps its specific properties distinct 
in its several forms, yet its symptoms are in appearance common to 
many other diseases, and in that light it cannot be said to have any 
one symptom peculiar to itself. For instance, every symptom of the 
venereal disease, in form of a gonorrhoea, may be produced by any 
other visible irritating cause; and often without any cause that can 
be assigned: even buboes and swelled testicles, which are symptoms 
of this disease, have followed both stimulating injections and bougies, 
when applied to the urethra of a sound person; and indeed these two 
symptoms, when they do arise from a venereal cause, in many cases, 
are only symptomatic, not specific, but more especially the swelled 
testicle. 

Sores on the glans penis, prepuce, &c. in form of chancres, may, 
and do arise without any venereal infection: although we may ob- 
serve that they are, in general, a consequence of former venereal 
sores which have been perfectly cured. 

The symptoms produced from the infection, when in the constitu- 
tion, are such as are common to many other diseases; viz. blotches 
on the skin are common to what is called scorbutic habits; pains 
common to rheumatism, swellings of the bones, periosteum, fascise 



CHAP. I. THE LUES VENEREA. 353 

&c. to many bad habits, perhaps, of the scrofulous and rheumatic 
kind. Thus, most of the symptoms of the venereal disease, in all 
its forms, are to be found in many other diseases; therefore, we are 
led back to the original cause, to a number of leading circumstances, 
as dates, and its effects upon others from connection when only local, 
joined with the present appearances and symptoms, before we can 
determine absolutely what the disease truly is; for all these taken 
together, may be such as can attend no other disease. However, with 
all our knowledge, and with all the application of that knowledge to 
suspicious symptoms of this disease, we are often mistaken, often 
calling it venereal when it is not; and sometimes supposing it to be 
some other disease when it is venereal. 

Rheumatism, in many of its symptoms, in some constitutions, re- 
sembles the lues venerea; the nocturnal pains, swelling of the ten- 
dons, ligaments, and periosteum, and pain in those swellings, are 
symptoms both of the rheumatism and the venereal disease, when it 
attacks those parts: I do not know that I ever saw the lues venerea 
attack the joints; though many rheumatic complaints of those parts 
are cured by mercury, and therefore supposed to be venereal. 

Mercury, given without caution, often produces the same symp- 
toms as rheumatism; and I have seen even such, supposed to be ve- 
nereal, and the medicine continued. 

Other diseases shall not only resemble the venereal in appearance, 
but in the mode of contamination, proving themselves to be poisons, 
by affecting the part of contact, and from thence producing immedi- 
ate consequences similar to buboes; also remote consequences simi- 
lar to the lues venerea. . 

As errors in forming a judgment of a disease lead to errors in the 
cure, it becomes almost of as much consequence to avoid a misiake 
in the one as in the other; for it is nearly as dangerous, in many con- 
stitutions, to give mercury where the disease is not venereal, as to 
omit it in those which are; for we may observe, that many of the 
constitutions which put on some of the venereal symptoms, when 
the disease is not present, are those with which mercury seldom 
agrees, and commonly does harm. I have seen mercury given in a 
supposed venereal ulcer of the tonsils, produce a mortification of 
those glands, and the patient has been nearly destroyed. 

When treating of the lues venerea, and giving the symptoms and 
oeneral appearances of the disease, I related some cases which ap- 
peared to be venereal, though they really were not; and I shall now 
refer the reader to these, as it will be unnecessary to give them again 
here although if thev had not been formerly taken notice of, this 

^d- eS £ W£ Sous, and not to be reduced to any 
svstn or order that I am acquainted with, I shall content myself 
with Hatino- the cases, and thereby put it in the power of others to 

v V 



J54 OF DISEASES RESEMBLING CHAr. U 

judge for themselves, if they should not be inclined to adopt the con- 
clusions I have drawn from them. 

On the 28th of July, 1776, a gentleman, then in the West Indies, 
scratched the end of his finger with a thorn. On the 31st he opened 
an abscess on the shoulder of a negro woman who had the yaws, and 
had been long subject to such abscesses in different parts of the body; 
and to incurable ulcerations afterwards. At the instant after the ope- 
ration, he perceived a little of the matter upon the scratch, and ex- 
claimed that he was inoculated. On the 2d of August, he amputat- 
ed a boy's finger, of thirteen years of age, for a sore resembling worm- 
eaten wood. The scratch on his finger did not 'heal, but from time 
to time threw off whitish scales: this appearance alarmed him, and 
he rubbed in mercurial ointment very freely. Notwithstanding 
this, in the month of September, a painful inflamed tumour appeared 
on the second joint of the finger, which was soon followed by several 
others on the back of the hand, in the course of the metacarpal bone 
of the fore-finger. He still continued the mercurial friction, but 
without effect, for the tumours daily multiplied; and by the month of 
November extended to within a small distance of the axilla. They 
did not go on to suppuration at this time. About the end of Novem- 
ber, he began to be affected with severe nocturnal pains in different 
parts of the body, but especially along the tibia and fibula, with fre- 
quent severe headaches, which continued to increase to an almost in- 
tolerable degree for five months, though he used mercurial friction, 
with decoction of sarsaparilla, every day in great quantity. 

In the month of May, 1777, a scabby eruption appeared in differ- 
ent parts of the body, especially the legs and thighs; and the before- 
mentioned tumours ulcerated; but this was followed by a remission 
of the nocturnal pains. 

He never could bring on a salivation, though his mouth was con- 
stantly tender, even for months. The ulcerations became daily worse 
and a voyage to England was thought the only resource. He arrived 
in London the 1st of August, and by the advice of Dr. William Hun- 
ter and Sir John Pringle, he began again a course of mercury and 
sarsaparilla, with a milk diet. I was called in, and judging that two- 
thirds of a grain of mercurius calcinatus, every day, was too small a 
dose, if it were judged to be venereal, it was ordered to be gradually 
increased to five grains; and he continued this course till November 
when all the sores were perfectly healed. 

He now discontinued the mercury, and remained free from all 
symptoms of the disorder, except some nodes on the tibia and rheu- 
matic pains on exposure to cold, until about twelve months ago when 
he began to have an uneasiness in swallowing, a rawness in the throat 
and a discharge of vised mucus from that and the posterior nostrils' 
all of which still continue. 

The following observations may be made on the above case-— 

lhere can be little doubt that the disease was the yaws. The 



CHAP. I. THE LUES VENEREA. 

yaws are a disease thai resembles the venereal in several of its symp- 
toms, as well as in the manner in which it is most commonly commu- 
nicated. It differs, however, in some essential particulars. The yaws 
have a regular progress, after going through which, they leave die 
constitution in a healthy state, at least free from that disease; it being 
sufficient for the cure, that the patient be put in a state favourable to 
general health. Thus, a negro labouring under the disease must do 
little or no work, be kept clean, and have a better diet than usual. 
Under these circumstances, he commonly gets well in from four to 
nine months; although the unfavourable cases will continue much 
longer. Various medicines are given for the cure; but it is not clear 
that any of them do good. Mercury has considerable power over 
the disease, without being a specific for it. If given early, it will 
either check the progress of the disease, or perhaps even heal up all 
the sores on the skin; but nothing is gained by this, for the disease 
soon breaks out anew. Some practitioners of medicine in the West 
Indies are of opinion, that interrupting the course of the disease by 
mercury is productive of no other evils than those of loss of time, 
and an imperfect cure: others affirm that it is often the cause of what 
they call thebone-ach. Towards the end of the disease, it is gene- 
rally allowed that mercury may be given safely, and even with ad- 
vantage. It is probable the long continuance of the disease, being 
above fourteen months, and also the pains in the bones in the present 
case, were owing to the very early and free use of mercury. It may 
be allowable to add, that the yaws do not differ more from the vene- 
real disease in curing themselves, than in this circumstance, that, like 
the small-pox, they affect none a second time. 

A gentleman applied to me for the cure of chancres, seated on the 
attachment of the prepuce to the penis, and also on the fraenum. 
Mercury was used chiefly bv friction, in order to affect the constitu- 
tion; it was also applied* to the sores, in order to affect them locally. 
The cure of the chancres went on gradually and without interrup- 
tion; and in about five weeks they were perfectly healed. He al- 
most immediately had connection with a woman, and long before we 
could suppose the mercury had all got out of Ins constitution. In a 
very few days after the first connection, the prepuce began to be 
chopped all-round on the edge of its reflection. He continued his 
connection, and upon its growing worse he applied to me, and I 
found the chops very deep, and the prepuce there so tight and sore, 
that he could not bring it back upon the penis. . 1 he question now 
was whether this was venereal or not? The sores themselves did 
not appear to be so; but more was to be taken into the account than 
simply appearances. It was first to be considered^ whether it might 
nossiblv be a return of his former complaint. Ihis could not be 
th case because the sores were not in the same parts. It was next 
to be Questioned, was it possible for this part of the prepuce to have 
been contaminated at the same time with the former, and the poison 



J5G OF DISEASES RESEMBLING CHAP. I- 

not to have come into action till now, having been prevented by the 
course of mercury, which had not cured the disposition? Has could 
not be well answered, although not probable, because the poison ap- 
peared to come too soon into action after the leaving off of the medi- 
cine; for I did suppose there was still a great deal of mercury in the 
constitution. Was it then possible for him to have caught it from 
the woman? This, I supposed, could not have been the cause of 
these chops, whatever effect this connection might have to render 
them venereal hereafter; for they appeared too soon after it, espe- 
cially as he had mercury in his constitution at the time, and as the 
parts had been accustomed to the application of venereal matter but 
a very little time before. Although, from all circumstances taken 
together, I was convinced the case was not venereal, yet an appre- 
hension arose in his mind concerning the possibility of having given 
it to the lady, as he had connection after the first appearance of the 
sores. I was equally-convinced of the impossibility of the one as of 
the other, therefore, desired him to rest easy on that head. He went 
immediately into the country, and, nothing being done for those 
chops, they got perfectly well. In less than a fortnight after this 
connection, the lady became a little indisposed with a slight fever; 
and a swelling came in one of her groins. I watched the progress 
of this swelling, which was slow, and I did not believe it to be vene- 
real. It at last formed matter and broke, and a poultice was applied 
to it. Instead of ulcerating or spreading, it rather had a healing 
disposition, and in about six weeks it was perfectly well. While it 
was healing, scurfy eruptions came out on the skin, some on the face 
and thighs, but more especially on the hands and feet, where the cu- 
ticle peeled off. Upon the first appearance of these, I was a little 
staggered; but as the sore was healing, I was unwilling to give cre- 
dit to the appearance, and therefore begged that nothing might be 
done; and they all got well. 

From the general outline of these cases, one would have naturally 
said they were venereal; but the particular circumstances being all 
investigated, and the whole taken together, led me to suppose that 
they were not, and the event proved that to be the case. 

The following case was communicated by Mr. French, of Har- 
pur-street. 

June the 9th, 1782, a gentleman applied to me for an ulcer which 
was seated on the glans penis, attended with excessive pain. Know- 
ing him to be an intemperate man, and learning from himself, that 
during a state of intoxication he had been connected with a woman, 
I judged the complaint to be venereal. He was now in a feverish 
state and unfit for the exhibition of mercury: I therefore prescribed 
for him decoction of bark, with elixir of vitriol and tinctura the- 
baica, proportioned to his pain. I directed him to abstain from 
every kind of fermented liquor; to live chiefly upon milk, and to 



CIIAP - r » THE LUES VENEREA. 357 

wash the ulcer with a linament composed of equal parts of oil of al- 
monds and aqua sapphirina. 

About the 17th of the same month, some check having been given 
to the fever,, the sore looking cleaner, and his pain having abated, I 
ordered him small doses of argentum vivum and extract of hem- 
lock. 

July the 4th, finding the mercurial course to disagree, I ordered 
three grains of the extract of hemlock to be taken two or three times 
a day, and the decoction of bark to be taken as before, with twenty 
drops of tinctura theb'aica, which was gradually increased to sixty, at 
bed-time. 

The ulcer had spread very much during the mercurial course, and 
had now destroyed half the glans penis. 

October 1st, Mr. Hunter was consulted, and ordered the patient to 
add the powder of sarsaparilla to the decoction of bark, to take lau 
danum freely, and wash the sores with tinctura theb'aica. Soon after 
beginning this course the remainder of the glans penis sloughed off; 
the parts gradually healed; and health was restored. 

There were other symptoms in this case which deserve to be taken 
notice of; a considerable enlargement of the scalp on the right side 
of the os frontis, and on the left parietal bone, attended with exces- 
sive pain, and vibices resembling the sea-scurvy on the inside of the 
left tibia, both of which disappeared in the course of the cure. 

Some months after, the tumor in the head returned, and several 
abscesses were formed which were opened, and the cranium found 
carious to a great extent. On account of the pain, he has for some 
months past taken two hundred and forty drops of laudanum, and 
six grains of opium, daily. These sores healed up, and others broke 
out in different parts of the head, which also got well; and in June, 
1785, there was only one large ulcer in the angle of the right eye. 

A lady was delivered of a child on the 30th of September, 1776. 
The infant being weakly, and the quantity of milk in the mother's 
breasts abundant, it was judged proper to procure the child of a per- 
son in the neighbourhood to assist in keeping the breasts in a proper 
state. It is worthy of remark, that the lady kept her own child to 
the right breast, the stranger to the left. In about six weeks the nip- 
ple of the left breast began to inflame, and the glands of the axilla 
to swell. A few days after, several small ulcers were formed about 
the nipple, which, spreading rapidly, soon communicated and became 
one ulcer, and at last the whole nipple was destroyed. The tumor 
in the axilla subsided, and the ulcer in the breast healed in about 
three months from its first appearance. On inquiry, about this time 
the child of the stranger was found to be short-breathed; had the 
thrush; and died tabid, with many sores on different parts of the 
body The patient now complained of shooting pains in dinerent 
parts of the body, which were succeeded by an eruption on the 
arms, legs, and thighs, many of which became ulcers. 



358 OP DISEASES RESEMBLING CHAP. I. 

She was now put under a mercurial course, with a decoction of 
sarsaparilla. Mercury was tried in a variety of forms, m solution, 
in pills internally, and externally in the form of ointment It could 
not be continued above a few days at a time, as it always brought oil 
fever or purging, with extreme pain in the bowels. In tins state she 
remained till March 26, 1779, when she was delivered of another 
child in a diseased state. This child was committed to the care of a 
wet nurse, and lived about nine weeks. The cuticle peeling off in 
various parts, and a scabby eruption covering the whole body. The 
child died. 

Soon after the death of the child, the nurse complained of head- 
ach and sore throat, together with ulceration of the breasts. Various 
remedies were given to her, but she determined to go into a public 
hospital, where she was salivated, and after some months she was 
discharged, but not cured of the disease. The bones of the nose and 
palate exfoliated, and in a few months she also died tabid. 

Of the various remedies tried by the lady herself, none succeeded 
so well as sea-bathing. About the month of May she began a course 
of the Lisbon diet-drink, and continued it with regularity about a 
month, dressing the sores with laudanum, by which treatment the 
sores healed up; and in September she was delivered of another 
child, free from external marks of disease, but very sickly; and it 
died in the course of the month. 

About a twelvemonth after, the sores broke out again, and al- 
though mercurial dressings and internal medicines were given, re- 
mained for a twelvemonth, when they began again to heal up. 

The following cases, being all derived from one stock, show as 
much as possible, that new poisons are rising up every day, and those 
very similar to the venereal in many respects, although not in all; 
therefore, it is the want of similarity that becomes the criterion to 
judge by, and not the similarity. The parents of the child who is 
the subject of the following history, were and are to all appearance 
healthy people. The child was weakly when born; and the mother 
having little or no milk, when it was three weeks old she gave it to 
a nurse whose milk was then seven months old, and was giving suck 
to her own child. The foster-mother allowed her own to suck the 
right breast, while the other sucked the left. 

The nurse observed that the skin of the foster-child began to peel 
off; but no rawness or soreness took place, except about the anus, 
where it looked as if scalded. The same kind of peeling took place 
on the lips, but they did not appear to be sore, although the people 
in the country said it was the thrush. The inner surface of the 
mouth and tongue appeared sound. In a fortnight after her receiv- 
ing the child it died, and then she allowed her own child to suck 
both breasts for three weeks; at the end of which she came to town 
to nurse a gentleman's child. 

She gave suck to the second child; but after being in town about 



CHAP. I. THE LUES VENEREA. 35D 

ten or eleven clays, she did not feel herself perfectly well; which 
made them suppose that the new mode of life, confinement in town, 
and probably better living, might not agree with her, and she went 
into the country and took the gentleman's child with her. About 
three or four days after she went to the country, for instance, about a 
fortnight after she took this child, and five weeks after the death of 
the first child, her left nipple, which the first nursed child had al- 
ways sucked, began to be sore, so that she could not let the child 
suck it. This ulcer on the nipple became extremely painful; in a 
day or two eruptions came out on her face, and soon after all over 
her body, but most on her legs and thighs. They continued coming 
out for about a fortnight, and had at first very much the appearance 
of the eruptions of the small-pox, and on the third day of their erup- 
tion were attended with fever, universal uneasiness, and great pain. 

Two or three days after the eruption on the skin appeared, one of 
the glands of the armpit began to swell, and formed matter, and was 
opened within a fortnight after its first appearance, and healed almost 
directly. Some of the eruptions increased fast, and became very 
broad sores, nearly of the size of a half-crown, especially on the legs 
and thighs, and were covered with a broad scab; many remained 
small, and only appeared like pimples. About a fortnight after the 
first appearance of the eruption, some began to die away; and in 
four weeks more, after this appearance, a foul ulcer attacked the left 
tonsil. 

The surgeon in the country, from all these circumstances, finding 
he could not get any ground by the before-mentioned treatment, de- 
termined to give her the solution of the corrosive sublimate, of which 
he gave half a grain in solution night and morning; in about a week 
there seemed to be a stop put to the swelling of the ulcers, and the 
discharge to be somewhat lessened, the ulcer in the throat putting on 
a better appearance. 

It was at this period I first saw her, which was about six weeks 
after the first appearance of the eruption, and a fortnight after the ap- 
pearance of the ulcer in the tonsil. The eruptions were then very 
much as before described; but the ulcer in the tonsil was clean and 
healing. From the history of the case I did conceive it not to be 
venereal; I therefore desired that all medicines might be left off, 
which medicines could only have been taken for a fortnight at most, 
because it was after the appearance of the ulcer on the tonsil the 
mercury was given, which was only of a fortnight's standing when 1 
saw her. She soon after recovered. 

After being well for some time, she again applied to the surgeon 
in the country, an abscess having formed where the complaint first 
be^an in the breast, attended with fresh eruptions on the face. 

The abscess was opened, and it healed up in a few days, and 
upon taking some cooling physic the eruptions disappeared She 
has continued very well ever since, without any other bad effect 



360 OF DISEASES RESEMBLING cHAP ' ** 

than the total loss of her nipple. This case was certainly understood 

to be venereal. „ , ,. ,* n „ rcP 

About five days after the appearance of the eruption on the ^nurse, 
the gentleman's child was taken away and given to a healthy woman, 
of a florid complexion, aged twenty-four years, and who had lain in 
with her first child eleven months when she became w et """" e l ° m \ 
child. After a few days she observed eruptions on the child s neao, 
not unlike those already described on the first nurse which it had 
sucked. Its mouth soon after became excoriated, so that it sucked 
with difficulty. After a short time those eruptions on the head be- 
came dry and peeled off, others appeared on the face knees and 
feet, but wholly unlike the former, as the first maturated, while the 
latter appeared only cutaneous, peeling off and leaving a circum- 
scribed spot of a light dun colour, which continued increasing tor hve 
weeks. These eruptions continued nearly three months from their 
commencement, at which period the child was extremely emaciated; 
but no particular treatment was indicated, so no medicine was ex- 
hibited, and in a few weeks after it came to London, and got per- 

fectlv well. 

The second nurse, a few days after giving suck to the child, had 
blotches appear on her left breast, precisely the same with those on 
the first nurse; with this difference only, that they were fewer in 
number, and attended with a greater degree of phlegmonous inflam- 
mation. They continued, and increased in size for seven or eight 
days; then the nipple of the same breast became ulcerated; the ul- 
ceration spreading so much as to endanger the loss of it; her thigh? 
now became diseased, and afterwards her legs. 

She suckled this child about twelve weeks. The disease seemed 
no longer to increase, and in twelve or fourteen days after this en- 
tirely disappeared, without her taking any medicine, except a few 
ounces of the decoction of the bark. The only application to the 
breast was unguentum simplex. 

The milk at this time became so small in quantity, that they were 
under the necessity of providing a third wet-nurse for the child, and 
the second returned to the country. Her own child being weaned, 
she had no further occasion for the milk, and in a few days it wholly 
disappeared; but by way of amusing the child when peevish, she al- 
lowed it to take the nipple, which had been diseased, in its mouth; 
the consequence was, that in a few days this child also became dis- 
eased in like manner with the former. She now applied to an emi- 
nent surgeon for assistance, who, not being acquainted with the history, 
supposed it venereal, and ordered a colourless medicine, supposed, from 
circumstances, to be the solution of sublimate, sixteen grains to half a 
pint of water; the dose a table-spoonful. She took this medicine as 
directed, and also gave it to her husband and child; the child a tea- 
Spoonful only at a time. While taking this medicine she got well. 

The third wet-nurse, like the former, was in a short time affected , 



9ECT - '• THE LUES VENEREA. 361 

but the blotches in this case were still fewer in number, the disease 
appearing to lose considerably in its power, as each fresh infection be- 
came less malignant than the former. She got well without taking 
any medicine. 



SECTION I. 

Of Diseases supposed to be Venereal, produced by transplanted 
Teeth. 

Since the operation of transplanting teeth has been practised in 
London, some cases have occurred in which the venereal infection 
has been supposed to be communicated in this way, and they have 
been treated accordingly; nor has the method of cure tended to 
weaken the suspicion: yet when all the circumstances attending 
them, both in the mode of catching the disease, and in the cure when 
they have been treated as venereal, are considered, there is some- 
thing in them all which is not exactly similar to the usual appearance 
of the venereal disease when caught in the common way; especially 
too when it is considered that some of the cases were not treated as 
venereal, and yet were cured, and therefore the cures of the others 
which appeared to be from mercury are not clear proofs of their 
having been venereal.* 

I believe that I have seen most, if not all the cases of this kind 
which have occurred, and have attended some of them. In all of 
them the time of local affection, after the insertion of the tooth, hath 
been almost regularly a month, which is too long for the venereal 
to take effect at a medium; and where they have produced con- 
stitutional symptoms, those again have either followed the local too 
close for the venereal, or too regular as to time. But it may be ad- 
vanced, that a disease has been produced probably as bad in its con- 
sequences as the venereal. That a disease has been formed in this 
wa\ is certain. 

The first case of this kind which came under my care was a lady 
who had one of the bicuspidati transplanted. The transplanted tooth 
fastened verv well. About a month after, she danced till five or six 
o'clock in the morning, caught cold, and had a fever in consequence, 

* It is to be remarked here that I do not, in the present case, lay any stress 
at all on my opinion of the lues venerea not having the power of contamination ; 
and I believe we must allow, if the disease were venereal, it must have been 
contracted from a lues venerea in the person from whom the tooth was taken ; 
for chancres are not common in the mouth, and they would be seen on examina- 
tion I believe few discharges similar to gonorrhoea take place there. 

z z 



362 OF DISEASES RESEMBLING CHAP ' *' 

which lasted near six weeks. In this time ulceration in the gum 
and jaw took place, though it was then not known. And when sue 
was beginning to recover, it was found that not only thegumand 
socket of this tooth were diseased, but also those of the eeth next to 
it. The two teeth were taken out, and the sockets of both afterwards 
exfoliated; but the parts were very backward in healing. 

This backwardness gave rise to various opinions, the principal oi 
which was, that it was venereal. In the mean time a rising appear- 
ed upon one of the legs, which was of the indolent node kind; this 
was also suspected by some to be venereal, or rather was a corrobo- 
rating circumstance of the former opinion; but I gave it as my opi- 
nion that it was not. I desired she might go to the sea and bathe 
which she did, and got perfectly well, both in the jaw and leg, and 
has continued so ever since. 

The second case of this kind I have seen was also in a young lady: 
the transplanted tooth fastened extremely well, and continued so for 
about a month, when the gum began to ulcerate, leaving the tooth 
and socket bare. The ulcer continued, and blotches appeared upon 
the skin, and ulcers also in the throat. The disease was treated as 
venereal, the complaints gave way to this course, but they recurred 
several times after very severe courses of mercury: however, she at 
last got well. 

The only observation I can make on this case is, that the symp- 
toms recurred after continued courses of mercury, much oftener than 
is usual in venereal cases; and I had my suspicions all along that it 
was scrofulous. 

The third case was of a gentleman, where the transplanted tooth 
remained, without giving the least disturbance, for about a month, 
when the edge of the gum began to ulcerate, and the ulceration went 
on till the tooth dropped out. Some time after, spots appeared al- 
most every where on the skin; they had not the truly venereal appear- 
ance, but were redder, or more transparent, and more circumscribed. 
He had also a tendency to a hectic fever, such as restlessness, want 
of sleep, loss of appetite, and headach. After trying several things, 
and not finding relief, he was put under a course of mercury, and all 
disease disappeared according to the common course of the cure of 
the venereal disease, and we thought him well; but some time after, 
the same appearances returned, with the addition of swelling in the 
bones of the metacarpus. He was now put under another